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.T ':eJ  o u r n pi  l 

Of  TH€  RRKRflSRS 
ffl€DICRL  SOCI€TV 


Vol.  XXXI 


Fort  Smith,  Arkansas,  June,  1934 


No.  1 


CONTENTS 

personal  and  news  items  __ 5 

A KS;,  M.  D _ , PR0CEED™GS  OE  SOCIETIES  6 


RESOLUTIONS 
EDITORIAL  COMMENT 
EDITORIAL 


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Published  monthly  under  direction  of  the  Council,  Arkansas  Medical  Society;  Dr.  W.  R.  Brooksher,  editor,  610 
First  National  Bank  Bldg;.,  Fort  Smith,  Ark.  Vol.  XXXI',  No.  1.  Subscription  $3  a year.  Single  copies  25  cents.  En- 
tered as  second-class  matter  June  21,  1906,  at  the  postoffice  at  Little  Rock,  Arkansas,  under  the  Act  of  Congress  of 
March  3,  1879.  Acceptance  for  mailing  at  special  rate  of  postage  provided  for  in  Section  1103,  Act  of  October  3,  1917, 
authorized  August  1,  1918. 


Digitized  by  the  Internet  Archive 
in  2016 


i 

https://archive.org/details/journalofarkansa3111arka 


FERGUS  O.  MAHONY,  M.  D.,  F.  A.  C.  P. 
El  Dorado 

President,  Arkansas  Medical  Society, 
1934-1935 


THE  JOURNAL 

of  the  ARKANSAS  MEDICAL  SOCIETY 


N RA 


it  00  OUR  PARI 


PUBLISHED  MONTHLY  UNDER  DIRECTION  OF  THE  COUNCIL 


Vol.  XXXI 


Fort  Smith  Arkansas,  June,  1934 


No.  1 


ANNUAL  ADDRESS 
Leonce  J.  Kosminsky,  M.  D. 
Texarkana 


Gentlemen  of  the  Arkansas  Medical  So- 
ciety, it  has  not  only  been  a great  honor  to 
be  your  President  for  the  past  year,  but  a 
pleasure  to  be  long  remembered.  I did  my 
best  to  visit  every  section  of  the  state  dur- 
ing the  past  year  and  visited  every  Coun- 
cilor District  meeting. 

The  year  has  been  a very  strenuous  and 
trying  one  for  the  medical  profession  with 
all  of  the  NR  A,  CWA,  PWA,  etc.,  and  with 
it  all  none  was  so  unsatisfactory  to  us  as 
the  Code  given  the  medical  man  with 
prices  most  absurd.  Your  committee  con- 
sisting of  the  President,  Secretary,  Chair- 
man of  the  Council  and  Chairman  of  the 
Legislative  Committee,  made  every  effort 
to  get  some  satisfactory  arrangement  and 
our  fee  bill  adopted,  all  to  no  avail. 

We  fully  realized  that  during  the  eco- 
nomic conditions,  it  was  a process  of  “give 
and  take”  but  for  some  unknown  reason 
the  medical  profession  as  usual  was  sup- 
posed to  give;  no  other  profession  or  busi- 
ness was  told  just  what  to  charge;  the 
merchant,  druggist,  real  estate  man  nor 
public  utilities  were  demanded  to  cut 
prices  at  all,  their  prices  were  either  ac- 
cepted or  rejected,  mostly  accepted. 

The  amount  of  charity  contributed  by 
the  doctor  in  this  country  amounts  to 
24.58  per  cent  of  his  time  which  he  can 
expect  no  compensation,  combined  with 
this  the  additional  one-fourth  which  he 
charges  and  cannot  collect,  it  will  readily 
show  that  one-half  of  the  doctor's  working 
hours  are  given  over  to  free  work.  It  has 
been  estimated  .that  the  American  doctors 
do  more  than  a million  dollars  worth  of 
charity  work  a day.  This  was  made  by  a 
careful  survey  not  confined  to  any  particu- 
lar section  of  the  country  but  the  country 
at  large. 


The  responsibility  for  charity,  both  med- 
ical and  otherwise,  properly  belongs  to 
philanthropic  agencies  and  with  our  mu- 
nicipal, state,  and  federal  governments 
and  not  with  the  doctor.  He  has  always 
been  and  will  continue  to  be  willing  to  do 
his  share  towards  the  delinquents  and 
needy  on  top  of  all  the  time  he  gives.  The 
doctor  is  among  the  first  called  upon  to 
donate  to  Community  Chest  and  various 
charity  funds ; the  old  idea,  all  give  and  no 
take  seems  to  apply  mostly  to  the  medical 
profession. 

The  question  is  asked,  “Should  medicine 
be  socialized?”  No.  There  has  been  too 
much  politics  and  bureaucracy  in  other 
fields,  as  well  as  ours.  The  remedy  must 
come  from  organized  medicine  whose  nu- 
cleus is  the  County  Medical  Society,  co-op- 
erating with  the  State  Society,  the  logical 
dictator  being  the  A.  M.  A.  The  county 
and  state  medical  societies  acting  in  an 
executive  capacity  thus  making  the  A.  M. 
A.  powerful  enough  to  initiate  and  enforce 
medical  policies. 

No  code  of  law  would  be  needed  where 
the  proper  code  of  ethics,  not  only  existed 
but  was  carried  out.  This  is  the  critical 
hour.  The  doctors  still  have  the  opportun- 
ity for  preventing  outright  socialization  of 
medicine,  by  presenting  a plan  of  their 
own  for  solving  the  problems  of  medical 
economics,  whether  by  group  practice, 
state  subsidy,  voluntary  insurance  or  what 
not.  If  the  doctors  unresentfully  lose  this 
opportunity,  a plan  of  medical  care  will 
arise  anyway;  but  it  will  come  in  the  worst 
way.  The  medical  profession  will  have 
forced  political  control  of  the  practice  of 
medicine  upon  themselves  by  fighting  it 
without  vision. 

® 

The  President  should  appoint  a chair- 
man of  the  State  Society  Public  Health 
Committee  and  he  appoint  members  of 
wide  experience  in  public  health  activities 
and  who  have  had  the  privilege  of  observ- 
ing and  sharing  in  work  of  state  wide  and 


2 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  1 


national  importance.  Each  County  So- 
ciety's Public  Health  committee  should 
make  such  an  analysis  and  furnish  con- 
structive criticisms  and  suggestions  to  the 
State  Society  and  for  their  own  County 
Society  Public  Health  development.  Coun- 
ty Societies  have  already  developed  quite 
extensive  programs. 

The  Time  Is  Ripe  For  Organized 
Effort 

If  the  medical  profession  is  to  regain 
leadership  in  the  health  field,  its  leaders 
must  clearly  define  the  health  needs  of  the 
present  day;  plan  a program  to  adequate- 
ly meet  these  needs;  organize  to  work 
these  plans  out  in  co-operation  with  other 
allied  workers  in  a practical  and  economic 
way  so  as  to  produce  convincing  results. 

This  is  a time  for  calm  and  straight 
thinking;  for  long  hard  hours  of  work. 
Shoulder  to  shoulder,  of  our  own  free  will, 
we  must  jvork  out  a plan  and  make  it  suc- 
cessful. Victory  is  on  the  side  of  organized 
effort  in  these  times.  Shall  we  organize 
or  wait  to  be  organized  for  health  service 
in  the  community?  We  shall  be  leaders 
only  as  a result  of  what  we  do,  not  because 
we  are  physicians! 

The  “Diphtheria  Project”  is  to  be  the 
chief  concern  of  the  Public  Health  com- 
mittee. Other  local  health  projects  will  be 
added  during  the  year.  The  single  project 
of  diphtheria  immunization  should  be  car- 
ried on  in  every  county.  Every  County 
Medical  Society  must  co-operate  in  diph- 
theria immunization  if  the  state  project 
is  to  achieve  the  success  we  predict  and 
hope  for,  particularly  in  the  early  years 
of  child  life. 

Infants  and  Toddlers  Preferred 

The  Public  Health  Committee  should  de- 
velop leaders  in  child  health  programs  in 
the  community.  The  practice  of  preven- 
tion really  begins  before  birth.  It  includes 
heredity,  but  we  cannot  do  much  about 
that  except  in  selected  cases.  The  physi- 
cian can  begin  soon  after  the  birth  of  the 
child  to  protect  the  infant  against  diph- 
theria. In  the  years  before  children  go  to 
school,  the  physician  can  immunize  any 
child  still  susceptible  to  diphtheria.  He 
can  watch  the  toddlers’  growth  and  devel- 
opment and  correct  significant  physical 
defects.  He  can  advise  parents  as  to  their 
child’s  habits  and  nutrition.  Care  of  the 


infant  and  the  pre-school  child  in  the  home 
is  the  objective  toward  which  the  physi- 
cian helps  and  guides  the  parents. 

Parental  Education 

Parental  education  should  be  more  prac- 
tical. Theoretical  and  pseudo-scientific 
parental  education  is  dangerous.  Young 
parents,  especially,  need  advice  because 
they  lack  experience. 

The  county  medical  society  members 
can  do  much  to  stabilize  this  worthy  en- 
deavor. Advice  must  be  based  upon  ex- 
perience and  understanding.  Such  advice 
can  be  given  by  an  experienced  physician. 
His  training  in  both  prevention  and  cure 
has  been  practical  as  well  as  scientific. 
Physicians  must  impress  upon  parents  the 
fact  that  the  best  advice  for  their  child  is 
that  which  is  adapted  to  his  needs  and 
capacities. 

After  all  is  said  and  done,  we  can  safely 
say  that  money  spent  in  dues  for  a local 
and  state  medical  society  is  one  of  the 
safest,  surest  investments  a physician  can 
make.  Gentlemen,  this  last  year  in  my 
travels  over  the  state,  I have  come  to  real- 
ize what  the  friendship  of  man  means ; the 
close  contact  with  you  men  in  our  profes- 
sion. 

So  long  as  we  love,  we  serve.  So  long 
as  we  are  loved  by  others  I would  almost 
say  that  we  are  indispensable;  and  no  man 
is  useless  while  he  has  a friend.  There  is 
nothing  quite  so  hygienic  as  friendship; 
to  love  and  be  loved  means — even  pulse, 
clear  eyes,  good  digestion,  sound  sleep — 
success. 


Have  YOU  immunized  all  children  over 
six  months  of  age  against  Diphtheria, 
seen  by  YOU  during  the  last  two  weeks? 

METHOD : One  injection  (1  c.c.)  of 
Toxoid  three  weeks  apart  for  three  in- 
jections. 

Have  YOU  vaccinated  all  children  un- 
der a year  of  age  against  smallpox  seen 
by  YOU  during  the  last  two  weeks? 

Have  YOU  provided  for  the  proper 
normal  feeding,  growth  and  development 
of  all  infants,  seen  by  YOU  during  the 
last  two  weeks? 

— Bulletin  Los  Angeles  County 
Medical  Society. 


i 


June,  1934] 


ARKANSAS  MEDICAL  SOCIETY 


3 


Resolutions 

Whereas,  the  Randolph  County  Medical 
Society  has,  in  the  death  of  Dr.  W.  E. 
Hughes,  lost  a valued  member,  and 

Whereas,  Dr.  Hughes  has  held  every  of- 
fice in  the  society  at  various  times  and 
has  given  much  of  his  time  and  talents  to 
the  well  being  of  the  society,  and 

Whereas,  the  society  feels  a deep  and 
irreparable  loss  in  the  demise  of  this  man. 

Therefore,  be  it  resolved,  that  we  adopt 
a resolution  of  respect  to  the  departed  one 
and  express  in  this  manner  to  the  bereav- 
ed family  and  the  public  our  appreciation 
of  the  life  that  has  gone  from  among  us. 

Be  it  further  resolved,  that  a copy  of 
this  resolution  be  placed  in  our  minutes,  a 
copy  sent  to  the  family,  a copy  to  the 
Journal  of  Arkansas  Medical  Society,  and 
a copy  furnished  the  press  for  publication. 
Adopted  April  3rd,  1934. 

J.  E.  Smith, 

M.  A.  Baltz, 

J.  R.  Loftis, 

Committee. 


At  a meeting  of  the  Southeast  Arkan- 
sas Medical  Society  held  at  Monticello, 
Arkansas,  Monday,  April  23d,  the  exami- 
nation of  pre-school  children  was  discuss- 
ed. The  difficulties  in  securing  thorough 
and  proper  examination  of  the  children 
when  huddled  in  large  groups  with  the  doc- 
tors operating  without  necessary  con- 
veniences and  trained  assistants  at  hand, 
such  as  has  been  the  case  in  the  past,  was 
discussed  at  length.  The  opinion  seemed 
to  prevail  that  in  order  to  give  the  child 
a fair  deal  and  to  make  the  examination 
thorough  rather  than  superficial,  it  would 
be  best  to  have  the  children  examined  in 
the  private  offices  of  the  doctors,  deliber- 
ately, rather  than  hurriedly,  as  in  the  past. 

Realizing  that  a certain  percentage  of 
the  parents  might  not  be  able  to  pay  for 
these  examinations,  the  doctors  have  of- 
fered to  take  care  of  all  of  these  at  no  cost, 
charging  only  a very  reasonable  fee  to 
those  able  to  pay  for  the  examination.  The 
following  resolution  was  offered  and  unan- 
imously adopted: 

Whereas,  the  function  of  the  P.  T.  A., 
the  medical  and  dental  professions,  among 
other  things,  is  to  prevent  sickness  and 


raise  the  health  standards  among  the 
school  children,  and 

Whereas,  the  advancement  of  the  child 
in  school  work  is  dependent  upon  a heal- 
thy body,  and 

Whereas,  the  first  years  in  school  are 
the  most  critical  in  that  the  change  in  en- 
vironment, added  restraints  and  compelled 
action  bring  about  physical  as  well  as  men- 
tal reactions,  therefore,  be  it 

Resolved,  by  the  P.  T.  A.,  the  medical 
and  dental  professions  represented,  that 
the  parents  of  all  pre-school  children  have 
their  children  carefully  examined  by  their 
family  physician,  or  physician  of  their 
choice,  and  their  physical  condition  certi- 
fied to  before  the  opening  of  school. 

$ 

EDITORIAL  COMMENT 
A limited  number  of  bound  copies  of 
The  Journal,  June  1933  to  May  1934,  are 
available  from  the  editor  at  a cost  of  three 
dollars  and  seventy-five  cents,  delivery 
charges  prepaid.  Readers  who  desire  to 
preserve  their  copies  will  find  this  a most 
convenient  and  inexpensive  way.  Remit- 
tance should  accompany  orders. 


This  issue  is  the  last  which  will  be 
mailed  those  physicians  whose  dues  for 
1934  are  not  paid.  See  your  county  secre- 
tary now  and  pay  your  dues  in  order  that 
your  membership  may  be  continuous. 
Membership  in  your  county  and  state  so- 
ciety is  a privilege  and  obligation;  the 
society  can  not  function  without  your  sup- 
port as  a paid-up  member. 

Arkansas  physicians  have  recently  been 
circularized  by  a mutual  insurance  com- 
pany, offering  mal-practice  insurance.  We 
should  like  to  call  attention  to  the  fact 
that  the  Arkansas  Medical  Society  has  a 
group  contract  with  one  of  the  best  com- 
panies in  this  line,  the  Aetna,  offering  a 
desirable  contract  at  a low  rate.  Experi- 
ence of  Arkansas  physicians  with  this  con- 
tract has  been  most  satisfactory.  The 
present  rate  is  predicated  on  group  cover- 
age; any  deviation  of  members  in  appre- 
ciable numbers  would  no  doubt  cause  an 
advance  in  the  minimum  rate  we  now  en- 
joy. The  Secretary  will  be  glad  to  furnish 
information  on  this  and  other  phases  of 
mal-practice  insurance  on  request. 


4 


THE  JOURNAL  OF  THE 


|Vol.  XXXI,  No.  1 


THE  JOURNAL 

OF  THE 

Arkansas  Medical  Society 


Owned  by  the  Arkansas  Medical  Society  and  Published 
under  direction  of  the  Council. 


DR.  W.  R.  BROOKSHER,  Editor 
610  First  National  Bank  Bldg'.,  Fort  Smith,  Arkansas 


Published  Monthly.  Subscription  $3.00  per  year;  sin- 
gle copies,  25  cents. 

Entered  as  second-class  matter  June  21,  1906,  at  the 
postoffice  at  Little  Rock,  Arkansas,  under  the  Act  of 
Congress  of  March  3,  1879. 

Acceptance  for  mailing  at  special  rate  of  postage  pro- 
vided for  in  Section  1103,  Act  of  October  3,  1917,  au- 
thorized August  1,  1918. 

The  advertising  policy  of  this  Journal  is  governed  by 
the  rules  of  the  Council  on  Pharmacy  and  Chemistry  of 
the  American  Medical  Association. 

All  communications  of  this  Journal  must  be  made  to 
it  exclusively.  Communications  and  items  of  general 
interest  to  the  profession  are  invited  from  all  over  the 
State.  Notice  of  deaths,  removals  from  the  State, 
changes  of  location,  etc.,  are  requested. 


OFFICERS  OF  THE  ARKANSAS  MEDICAL  SOCIETY 

F.  O.  MAHONY,  President El  Dorado 

M.  E.  MeCASKILL,  President-Elect  ...  Little  Rock 
A.  M.  ELTON,  First  Vice-President  Newport 

S.  C.  FULMER.  Second  Vice-President  . Little  Rock 
F.  D.  SMITH.  Third  Vice-President  Blytheville 

R.  J.  CALCOTE,  Treasurer  ..  ...  Little  Rock 

W.  R.  BROOKSHER.  Secretary  , Fort  Smith 


COUNCILORS 

First  District — W.  M.  MAJORS  .Paragould 

Second  District — S.  J.  ALLBRIGHT  Searcy 

Third  District — M.  C.  JOHN  Stuttgart 

Fourth  District — C.  W.  DIXON  ....  . . Gould 

Fifth  District — L.  L.  PURIFOY  El  Dorado 

Sixth  District — DON  SMITH  Hope 

Seventh  District — GEO.  B.  FLETCHER  Hot  Springs 
Eigh'h  District — S.  B.  HINKLE  Little  Rock 

Ninth  District — D.  L.  OWENS  ... . Harrison 

Tenth  District — S.  J.  WOLFERMANN  ..  Fort  Smith 


OUR  PRESIDENT 

Dr.  Fergus  0.  Mahony  was  born  in  El 
Dorado,  Union  County,  Arkansas,  July  30, 
1879.  He  is  the  son  of  Edmund  and  Mary 
Klopher  Mahony,  deceased.  During  his 
early  life  he  attended  the  public  school  at 
El  Dorado.  In  1901  he  entered  as  an 
academic  student  the  University  of  Ark- 
ansas, and  there  remained  until  1904,  at 
which  time  he  became  a candidate  for  the 
doctorate  degree  at  the  School  of  Medicine, 
Tulane  University,  where  he  graduated  in 
1908. 

In  December,  1908,  Dr.  Mahony  was 
married  to  Miss  Minnie  MaGuire,  also  a 
native  of  Union  County.  Three  children 
were  born  to  this  union,  two  boys  and  one 
girl.  The  oldest  child,  a daughter,  is  now 
married  and  lives  in  Texas.  Dr.  Mahony 
is  proud  to  announce  himself  a grand- 
father, a son  having  been  born  about  a year 
ago  to  his  daughter. 


Soon  after  graduating  from  medical 
school,  Dr.  Mahony  became  engaged  as 
Assistant  Surgeon  for  the  Union  Saw  Mill 
Company  of  Huttig;  later,  during  the 
period  1911-1913,  he  held  a similar  posi- 
tion with  the  Wisconsin  Lumber  Company, 
also  of  Huttig.  During  the  summer  of 
1914,  he  returned  to  El  Dorado,  where  he 
formed  a partnership  with  a very  charm- 
ing and  distinguished  physician,  Dr.  R.  A. 
Hilton.  His  association  with  Dr.  Hilton  is 
to  him  a fond  and  sacred  reminiscence, 
prematurely  interrupted  by  the  death  of 
this  very  dear  friend.  He  has  served  as 
Local  Surgeon  for  the  Missouri  Pacific 
Railroad  for  the  past  twenty-five  years. 
In  1929  he  was  elected  Chief  of  Staff  of 
Warner  Brown  Hospital  of  El  Dorado, 
which  assignment  he  now  holds. 

Even  though  a busy  physician,  Dr.  Ma- 
hony has  maintained  much  civic  interest. 
During  the  period  1916-1920,  he  served 
on  the  City  Council  of  El  Dorado.  During 
the  period  1917-1920,  he  served  as  City 
Health  Officer,  and  was  again  appointed 
to  this  office  in  1930,  a position  which  he 
now  holds.  During  the  years  1917-1929, 
he  held  the  office  continuously  as  County 
Health  Officer  and  was  again  reinstated 
in  1933.  In  1917  he  was  appointed  by  the 
Governor  as  a member  of  the  Arkansas 
State  Board  of  Health,  representing  the 
Seventh  Congressional  District.  This  ap- 
pointment has  been  continuous,  being  re- 
newed by  our  present  Governor.  He  is  a 
member  of  the  El  Dorado  Rotary  Club 
and  was  for  three  years  Exalted  Ruler  of 
the  B.  P.  O.  E.  He  is  Past  Master  of  the 
Roland  Lodge  No.  594,  and  was  granted 
the  pleasure  of  raising  his  son  to  the  Mas- 
ters Degree  in  the  Masonic  Lodge.  Dr. 
Mahony  is  an  Odd  Fellow  and  also  a mem- 
ber of  the  Knights  of  Pythias ; he  is  a 32d 
Degree  Mason  and  a Shriner. 

Dr.  Mahony  is  a staunch  supporter  of 
organized  medicine.  He  has  served  at  va- 
rious times  as  President  and  as  Secretary 
of  the  Union  County  Medical  Society.  He 
is  a member  of  the  American  Medical  As- 
sociation, the  Southern  Medical  Associa- 
tion and  also  the  Arkansas  Medical  So- 
ciety. The  American  College  of  Physi- 
cians, which  was  caused  to  convene  in 
Minneapolis  during  the  year  1930,  elected 
him  to  fellowship.  During  the  World  War 


June,  1934] 


5 


ARKANSAS  MEDICAL  SOCIETY 


he  served  as  a Medical  Member  of  the  local 
Board. 

While  serving  as  part-time  City  and 
County  Health  Officer,  Dr.  Mahony  has 
had  an  opportunity  of  studying  seriously 
the  field  of  Public  Health.  He  believes 
that  every  practitioner  should  be  a health 
officer,  spreading  the  doctrine  of  preven- 
tive medicine  among  his  clientele.  He 
recognizes  fully  the  need  of  close  co-ordi- 
nation with  the  medical  fraternity  of  both 
official  and  non-official  health  agencies. 
In  1933  he  was  commissioned  by  the  Sur- 
geon General  of  the  United  States  Public 
Health  Service  as  Surgeon  in  the  Reserve 
Corps. 

So  to  us  as  our  president  for  1934-1935, 
Dr.  Mahony  brings  the  heritage  of  mature 
experience,  the  mellowing  influence  of  the 
bedside,  the  wisdom  from  past  conflicts 
and  decisions.  Under  his  leadership  we 
shall  continue  our  healthy  growth,  meet 
and  solve  our  new  problems,  continue  to 
uphold  the  honored  traditions  of  the  medi- 
cal profession,  and  to  serve.  We  pledge 
him  our  hearty  co-operation  and  unified 
support. 


Personal  and  News  Items 


The  following  physicians  hold  interest- 
ing attendance  records  for  meetings  of  the 
state  society;  Frank  Vinsonhaler,  Little 
Rock,  has  attended  39  of  a possible  41 
meetings.  Absent  from  one  while  in  ser- 
vice in  France;  from  the  other  attending 
dedication  of  a building  of  Duke  Univer- 
sity as  a delegate  from  the  Society. 

M.  L.  Norwood,  Lockesburg. — In  at- 
tendance at  each  meeting  since  1898  ex- 
cept two,  unable  to  attend  because  of  ill- 
ness in  his  family.  Has  attended  36  out 
of  38  possible  meetings,  23  consecutively. 

E.  E.  Barlow,  Dermott — has  attended  28 
out  of  a possible  31  meetings. 

L.  T.  Evans,  Batesville — has  attended 
24  consecutive  meetings. 

Earle  H.  Hunt,  Clarksville — has  attend- 
ed 25  out  of  a possible  26,  22  of  these  con- 
secutively. 

S.  J.  Allbright,  Searcy — has  attended  20 
out  of  a possible  21  meetings,  19  consecu- 
tively. 

J.  M.  Lemons,  Pine  Bluff — has  attended 
14  out  of  a possible  15  meetings,  missing 
one  because  of  illness. 


Monroe  County  Medical  Society  adds 
another  100  per  cent  distinction  by  regis- 
tering every  member  at  the  Little  Rock 
meeting. 

J.  B.  Jameson  addressed  the  Camden 
Lions’  Club  April  11th  on  “Public  Health.” 

Val  Parmley  addressed  the  following 
groups  on  legislative  policies  of  the  medi- 
cal and  allied  professions:  Seventh  Dis- 
trict Arkansas  Pharmaceutical  Associa- 
tion, Little  Rock,  at  its  April  meeting  on 
“Closer  Co-operation  Between  Druggists 
and  Doctors”;  Ninth  District  Arkansas 
Pharmaceutical  Association,  Hot  Springs 
National  Park,  May  7th;  Arkansas  Hos- 
pital Association,  Little  Rock,  May  9th, 
and  Arkansas  Dental  Association,  May 
16th. 

“A  Retrospect  and  Some  Brief  Sugges- 
tions Concerning  Acute  Appendicitis,”  by 
G.  E.  Cannon,  of  Hope,  appears  in  the 
April  1934  issue  of  the  Tri-State  Medical 
Journal. 

Dr.  J.  A.  King  has  recently  opened  a six- 
room  hospital  with  a bed  capacity  of 
eighteen  at  Elaine. 

Frank  Vinsonhaler  addressed  the  Little 
Rock  Civitan  Club  May  4th  on  “The  Life 
of  Albert  Pike.” 

The  Journal  congratulates  the  following 
on  their  selection : 

J.  M.  Kolb,  Clarksville,  director  of  Lions 
Club. 

S.  A.  Drennen,  Stuttgart,  president  of 
Arkansas  Booster  Club. 

H.  Fay  H.  Jones,  Little  Rock,  vice-com- 
mander of  Little  Rock  Chapter  Military 
Order  of  the  World  War. 

J.  T.  Powell,  Gravette,  city  health  of- 
ficer. 

H.  K.  Carrington,  Magnolia,  city  health 
officer. 

0.  R.  Kelly,  Sheridan,  President  of  Ro- 
tary Club. 

W.  J.  Blackwood,  Rector,  Director  of 
school  board. 

C.  H.  McKnight,  Brinkley,  Director  of 
Rotary  Club.  

Sixty-five  physicians  were  the  guests  of 
the  Cooper  Clinic  staff,  Fort  Smith,  May 
12th,  to  hear  Dr.  Louis  Rudolph,  of  Chi- 
cago, speak  on  “Vertex  Dystocia.”  A 
Dutch  lunch  was  served  after  the  address. 


6 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  1 


Proceedings  of  Societies 


White  County  Medical  Society  met  April 
11th  at  the  home  of  A.  G.  Harrison,  Sear- 
cy, for  the  following  program  presented 
by  the  staff  of  St.  Vincent’s  Infirmary, 
Little  Rock : 

Diabetes — S.  C.  Fulmer. 

Spina  Bifida — F.  Walter  Carruthers. 

Amebic  Dysentery — Homer  Higgins. 

Calcified  Fetus — S.  P.  Bond. 

Diseases  of  the  Pancreas — George  B. 
Lewis. 

M.  J.  Kilbury  discussed  the  pathological 
findings,  and  W.  E.  Gray,  Jr.,  the  roent- 
gen-ray findings  in  the  cases  reported. 


The  Sebastian  County  Medical  Society 
held  its  regular  session  in  Sallisaw,  Okla- 
homa, May  8th  with  Drs.  Morrow,  Cheek 
and  Jones  of  Sallisaw  as  hosts  for  dinner. 
Twenty-five  members  attended  the  first 
meeting  of  this  society  ever  to  be  held  out 
of  Fort  Smith.  Thirty-five  physicians 
were  present  to  hear  the  following  pro- 
gram: Nephritis — H.  C.  Dorsey;  Jaun- 

dice— S.  J.  Wolfermann. 

J.  W.  Amis,  Secretary. 


Dr.  Ernest  Sachs,  Saint  Louis,  address- 
ed the  Pulaski  County  Medical  Society, 
May  14th  on  “Diagnosis  and  Treatment  of 
Diseases  and  Injuries  of  the  Spinal  Cord.” 


Members  of  the  Sebastian  County  Med- 
ical Society  were  guests  of  the  Muskogee, 
Oklahoma,  County  Medical  Society  for  a 
dinner  meeting  at  the  Baptist  Hospital, 
Muskogee,  May  14th.  The  following  pro- 
gram was  presented: 

The  Decline  of  Prescription  Writing — 
C.  H.  Kennedy. 

Some  Salient  Points  in  the  Management 
of  Labor — C.  B.  Billingsley. 

Unusual  Malignancies  of  the  Face — D. 
W.  Goldstein. 


Dr.  Harold  Swanberg,  Quincy,  address- 
ed the  Sparks  Memorial  Hospital  staff, 
Fort  Smith,  May  7th,  and  the  Garland 
County-Hot  Springs  Medical  Society,  May 
8th,  on  “Radium  Treatment  of  Abnormal 
Bleeding,”  and  the  Craighead-iPoinsett 


County  Medical  Society,  Jonesboro,  May 
9th,  on  “Radium  Treatment  of  Carcinoma 
of  the  Cervix.” 


The  Lincoln  County  Medical  Society 
held  its  38th  anniversary  meeting  at  Star 
City  May  7th,  honoring  B.  F.  Tarver,  Star 
City  and  A.  S.  J.  Collins,  Monticello,  the 
only  living  charter  members.  Guest  speak- 
ers were:  W.  F.  Smith,  A.  C.  Shipp  and 
L.  F.  Barrier,  of  Little  Rock. 


Harvey  S.  Thatcher,  Little  Rock,  ad- 
dressed the  Southeast  Arkansas  Medical 
Society  at  Monticello,  April  23rd. 


The  First  Councilor  District  Medical  So- 
ciety met  at  Jonesboro,  May  3rd,  with  the 
following  scientific  program: 

Infections — P.  M.  Lutterloh,  Jonesboro. 

Endocrinology — W.  T.  Black,  Memphis. 

Common  Summer  Disorders  in  Children 
and  Procedure  of  Treatment — R.  C.  Tay- 
lor, Memphis. 

Classification  and  Management  of  the 
Average  Maternity  Case — S.  B.  Hinkle, 
Little  Rock. 

A Clinico-Pathological  Discussion  of  the 
Diseased  Cervix — Phil  C.  Schreier,  Mem- 
phis. 

Goiter,  A Preventable  Disease — E.  M. 
Holder,  Memphis. 

About  sixty  physicians  were  in  attend- 
ance. Ralph  Sloan,  Jonesboro,  was  elect- 
ed secretary-treasurer. 

F.  D.  Smith,  Secretary. 


The  Tri-County  Medical  Society  met  at 
Arkadelphia,  April  26th,  the  following  pro- 
gram being  presented: 

The  Allergic  Individual — A.  G.  Cazort, 
Little  Rock. 

Osteomyelitis — F.  W.  Carruthers,  Little 
Rock. 

Burns  and  Shock  from  Electricity — L. 
Val  Parmley,  Little  Rock. 

The  next  meeting  will  be  held  at  Hope 
on  May  31st. 

C.  K.  Townsend,  Secretary. 


A tuberculosis  case-finding  clinic  was 
conducted  by  the  Monroe  County  Medical 
Society  at  Brinkley  on  April  3rd  and  4th, 
with  Drs.  J.  J.  Willingham,  State  Sanato- 


June,  1934] 


ARKANSAS  MEDICAL  SOCIETY 


7 


rium,  and  S.  C.  Fulmer,  Little  Rock,  as- 
sisting. Hugh  Brown,  of  the  McRae  Me- 
morial Sanatorium,  examined  the  negroes. 
One  hundred  and  one  examinations  were 
made  and  379  Mantoux  tests  made.  The 
Monroe  County  Medical  Society  met  at  the 
Rusher  Hotel,  April  3rd,  in  dinner  session. 
The  following  program  was  presented: 

Incidence  of  Tuberculosis — J.  J.  Wil- 
lingham. 

Classification  of  Diseases  of  the  Heart 
— S.  C.  Fulmer. 

C.  A.  Henry,  Secretary. 


The  Lawrence  County  Medical  Society 
met  at  Alicia,  May  8th,  with  Drs.  C.  C. 
Ball,  Ravenden,  and  J.  H.  McCurry,  Cash, 
presenting  the  scientific  program. 


Obituary 


DR.  S.  A.  COLLUM,  Sr.,  a pioneer 
Texarkana  physician,  died  at  his  office  on 
the  afternoon  of  April  26th  following  a 
heart  attack.  Although  Dr.  Collum  had 
suffered  similar  attacks  in  the  past  several 
years,  he  was  in  apparent  good  health  and 
had  been  performing  his  usual  profes- 
sional duties  at  the  time  of  his  death.  Dr. 
Collum  was  born  in  Bowie  County,  Texas, 
September  30,  1866,  and  completed  the 
grade  and  high  schools  of  that  county  to 
later  enter  the  University  of  Texas.  Fol- 
lowing his  graduation  from  the  University 
of  Louisville  in  1892,  he  began  practice  in 
Texarkana,  where  he  grew  in  the  esteem 
and  affection  of  his  fellow-citizens.  He 
was  a fellow  of  the  American  College  of 
Surgeons,  a past  president  of  the  North 
Texas  Medical  Society,  a member  of  the 
Bowie-Miller  County,  the  Texas  State,  the 
Arkansas  and  the  American  Medical  Asso- 
ciations. He  was  one  of  the  organizers 
and  at  the  time  of  his  death,  president  of 
the  Texarkana  Hospital.  He  was  a mem- 
ber of  the  Rotary  Club  of  Texarkana, 
which  has  honored  his  memory  by  desig- 
nating its  annual  contribution  to  the  re- 
habilitation of  crippled  children,  to  whom 
Dr.  Collum  had  devoted  many  hours,  as 
the  Collum  contribution.  For  several  years 
he  served  as  an  officer  and  member  of  the 


Board  of  Health  of  Texarkana,  and  was  an 
elder  of  the  First  Presbyterian  Church. 
He  is  survived  by  his  wife,  two  daughters, 
Mrs.  G.  0.  Gantt,  of  Houston,  Mrs.  James 
F.  Warren,  of  Texarkana;  one  son,  Dr.  S. 
A.  Collum,  Jr.,  and  two  brothers,  John 
and  Bob,  of  Texarkana. 


DR.  ALBERT  I.  MOORE,  Fayetteville, 
age  72,  died  at  his  home  May  8th.  He 
graduated  from  the  University  of  Michi- 
gan in  1884  and  first  located  at  Hindsville, 
joining  his  brother,  the  late  Dr.  John 
Moore.  He  moved  to  Fayetteville  in  1895. 
In  addition  to  his  wife,  two  daughters  and 
a sister,  he  is  survived  by  a brother,  Dr. 
Will  Moore,  of  Rogers. 


DR.  C.  B.  PATTON,  aged  90,  a retired 
physician,  died  at  his  home  in  Batesville, 
May  3rd.  He  was  a graduate  of  Tulane 
University  and  had  practiced  medicine  fif- 
ty years.  He  served  with  the  21st  Texas 
Cavalry  throughout  the  Civil  War.  He  is 
survived  among  others  by  his  daughter, 
Mrs.  J.  M.  Hooper,  of  Batesville. 


DR.  OLEANDER  HOWTON  of  Luxora, 
died  at  a hospital  in  Memphis  May  7th,  24 
hours  after  he  had  arrived  at  the  hospital 
to  accompany  his  wife,  who  had  been  con- 
fined there  two  weeks,  back  to  Luxora. 

A native  of  Dawson  Springs,  Ky.,  Dr. 
Howton  practiced  medicine  in  Mississippi 
county,  Arkansas,  25  years.  He  was  at 
Osceola  before  going  to  Luxora.  He  was 
a graduate  of  the  Hospital  College  of  Med- 
icine, Louisville,  in  1903. 

Besides  his  wife,  Dr.  Howton  is  sur- 
vived by  a daughter,  Mrs.  John  Thweatt 
of  Luxora,  and  a brother,  Lonzo  Howton 
of  Osceola. 


ANNOUNCEMENT 

The  Gynecean  Hospital  Institute  of  Gynecologic 
Research  of  the  University  of  Pennsylvania,  is 
conducting  an  intensive  study  of  families  into 
which  congenitally  malformed  individuals  have 
been  born. 

Special  interest  centers  in  families  in  which 
malformations  have  appeared  in  two  or  miore 
children.  Physicians  who  have  knowledge  of  any 
such  families  are  urged  to  communicate  with  Dr. 
Douglas  P.  Murphy,  Gynecean  Hospital  Institute, 
University  of  Pennsylvania,  Philadelphia,  Pa. 


8 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  1 


PROCEEDINGS 

OF  THE 

FIFTY-NINTH  ANNUAL  SESSION 

OF  J HE 

ARKANSAS  MEDICAL  SOCIETY 


Little  Rock,  April  16,  17,  18,  1934 


HOUSE  OF  DELEGATES 
Monday  Morning,  April  16 

The  House  of  Delegates  was  called  to 
order  at  9 :30  a.  m.  by  the  President  L.  J. 
Kosminsky. 

The  roll  of  delegates  was  called,  which 
disclosed  a quorum  present. 

Joseph  Shuffield,  of  Little  Rock,  J.  G. 
Gladden,  of  Western  Grove,  and  Wm. 
Johnson,  of  Hardy,  were  appointed  as  cre- 
dentials committee. 

By  motion  the  minutes  of  the  58th  An- 
nual Meeting  as  published  in  the  July, 
1933,  issue  of  the  Journal  were  adopted. 

Fay  Jones,  of  Little  Rock,  H.  Moulton, 
of  Fort  Smith,  and  Earle  Hunt,  of  Clarks- 
ville, were  appointed  Reference  Commit- 
tee. 

The  next  order  of  business  was  the  pres- 
ident’s address  by  L.  J.  Kosminsky: 

Gentlemen:  I will  not  give  you  an  address, 

because  I have  a message  to  deliver  this  after- 
noon to  the  General  Session,  but  the  program 
committee  put  me  down  for  one  before  you.  I 
just  want  to  make  a few  remarks,  to  tell  you 
that  it  has  been  an  extreme  pleasure  and  a dis- 
tinct honor  to  serve  you  to  the  best  of  my  ability 
as  President  of  the  Arkansas  Medical  Society, 
Arkansas  the  State  of  my  birth  and  of  my  rear- 
ing. No  man  can  feel  prouder  or  happier  to 
occupy  this  position  than  I have  been.  No  mat- 
ter what  position  I might  ever  hold  in  the  future, 
there  will  be  none  more  gratifying  to  me  than 
that  of  representing  my  own  profession.  The 
past  year  has  been  a hard  and  trying  one,  but 
I am  happy  to  report  that  our  membership  is 
near  the  900  mark,  although  there  are  a total  of 
1,800  or  2,000  physicians  who  are  eligible  to  mem- 
bership. So  you  see  that  organized  medicine 
has  a minority.  Now,  gentlemen,  when  we  stand 
on  the  inside  with  900  members,  and  on  the  out- 
side there  are  about  1,100,  we  haven’t  that  hearty 
co-operation  and  the  organization  that  we  should 


have.  Gentlemen,  if  you  want  to  accomplish  any- 
thing, there  must  be  unity;  unity  in  strength, 
unity  in  purpose  and  unity  in  power.  I sincere- 
ly hope  that  the  members  who  are  present  and 
those  who  have  seen  fit  to  become  members  of 
the  society  will  consider  it  their  duty  as  mem- 
bers to  try  and  get  every  eligible  physician  in 
Arkansas  to  become  a member  of  his  component 
county  society  and  thereby  a member  of  the  state 
society. 

There  are  a good  many  things  that  the  mem- 
bers of  the  Arkansas  Medical  Society  might  be 
able  to  do.  According  to  statistics,  the  national 
mortality  rate  in  Japan  was  only  2.7  per  thou- 
sand as  compared  to  6.7  in  the  United  States,  this 
record  covering  a period  of  25  years.  It  has  been 
shown  that  65  per  cent  of  the  deaths  among  moth- 
ers in  child  birth  could  be  avoided  if  better  care 
were  taken.  That  doesn’t  sound  very  good  for 
a country  as  far  advanced  as  ours.  This  applies 
to  the  entire  country,  and  it  is  high  time  that 
laws  should  be  passed  confining  the  care  of  ma- 
ternal cases  to  educated  and  properly  equipped 
men.  The  future  advance  of  our  country  rests 
with  the  oncoming  generation.  If  we  have  such 
a large  death  rate  in  this  country  as  compared 
to  Japan,  it  must  be  the  fault  of  the  legislatures 
in  the  various  states  in  permitting  midwives  to 
practice  in  confinement  cases,  with  uncleanliness 
and  insanitary  conditions  necessarily  following.  I 
hope  that  the  next  legislative  committee  will  take 
this  message  to  heart  and  see  if  we  can  not  cor- 
rect this  evil. 

Gentlemen,  there  is  another  thing  that  the  med- 
ical profession  has  neglected,  which  I have  tried 
in  my  feeble  way  to  impart  to  the  profession  in 
my  various  visits  over  the  state.  The  medical 
profession  forgets  to  exercise  its  right  of  fran- 
chise on  election  day.  There  is  no  set  of  men 
anywhere  who  are  better  qualified  to  pass  on  a 
man’s  qualifications  for  any  public  office.  Why 
shouldn’t  the  doctor  be  better  qualified  to  tell  you 
if  any  man,  whose  family  he  has  ministered  to  in 
sickness  and  distress,  is  fit  to  fill  a public  office? 
It  is  your  duty  and  my  duty  in  this  coming  elec- 
tion to  see  that  we  send  men  to  the  legislature 
and  to  various  offices  in  the  various  communi- 
ties in  the  state  and  nation  who  are  unbiased, 
men  who  are  bi*oad  enough  to  give  every  one  an 
equal  share  and  an  equal  right.  That  doesn’t 
mean  that  the  medical  profession  should  run  the 
politics  of  the  state  but  the  medical  profession 


June,  1934] 


ARKANSAS  MEDICAL  SOCIETY 


9 


must  realize  that  it  is  their  duty  to  their  com- 
munity, to  their  state  and  nation,  to  see  that  men 
who  are  broad,  qualified,  men  of  the  right  type, 
good,  noble,  and  upright  men,  should  fill  these 
offices,  and  we  should  let  our  friends  know  the 
kind  of  men  we  are  supporting. 

Now,  in  seeking  support  for  the  various  chari- 
ties, the  parties  at  the  head  of  the  campaigns 
seek  the  doctors,  figuring  that  the  doctors  should 
donate  a big  lump  sum,  and  they  put  him  down 
for  such,  never  stopping  to  realize  the  amount  of 
charity  that  the  doctor  does.  There  is  not  any 
man,  who  has  the  honor  and  distinction  of  being 
called  a doctor,  who  has  ever  refused  in  time  of 
emergency  to  bear  his  share.  In  fact,  he  has 
always  done  more.  And  I want  to  say  that  there 
is  no  set  of  men  in  the  state  of  Arkansas  who 
are  broader,  higher-minded  men  than  the  men 
who  are  members  of  the  Arkansas  Medical  So- 
ciety. 

Gentlemen,  I hope  you  will  bear  in  mind  that 
this  has  been  an  extremely  hard  year  to  me  be- 
cause the  old  wheel  horse,  the  man  who  lived, 
who  ate,  who  slept  and  who  dreamed  organized 
medicine  was  taken  from  us  early  in  my  adminis- 
tration, a man  who  I intended  to  lean  on  with  all 
power  and  all  force,  a man  you  all  knew  and 
loved,  a man  lost  not  only  to  the  Arkansas  Medical 
Society  and  the  medical  fraternity,  but  to  this 
great  country  of  ours,  and  I speak  of  none  other 
than  our  departed  secretary,  Dr.  Bathurst.  I 
will  ask  this  House  of  Delegates  to  rise  now  in 
a 30  second  silent  devotion  to  memory  of  Dr. 
Bathurst.  (The  House  stood  in  silent  devotion.) 

When  the  Council  met  to  elect  his  successor, 
they  chose  a young  man  of  Fort  Smith,  Dr. 
Brooksher,  and  in  all  sincerity,  gentlemen,  I want 
to  say  that  that  young  man  has  done  wonderful’y 
well.  I have  never  called  upon  him,  morning, 
noon  or  night,  to  meet  me  in  any  section  of  the 
state  that  he  has  not  responded.  It  is  going  to 
be  a task  for  anybody,  I don’t  care  who  it  might 
be,  to  fill  the  shoes  of  our  departed  secretary. 
It  is  going  to  take  many  and  many  a year  for 
this  man  to  become  acquainted  with  the  sur- 
roundings, because  the  man  we  lost  governed 
without  any  ostentation.  He  was  mild,  meek  and 
friendly  to  every  one;  you  never  got  an  opinion 
from  him  unless  you  pumped  it  out  of  him;  and 
the  man  who  can  live  that  kind  of  life  and  de- 
part loved  and  respected  by  every  one  has  a great 
task  before  him. 

Now,  it  is  up  to  the  members  of  this  society  to 
lend  their  co-operation  to  those  who  advertise 
in  our  Journal  by  patronizing  these  advertisers, 
everything  else  being  equal.  When  you  pass  in 
and  out  of  this  hall,  stop  at  the  exhibits  they 
have.  These  men  are  friends  of  the  Arkansas 
Medical  Society.  They  spend  their  money  to  dis- 
play their  exhibits.  Let’s  spend  a few  moments 
of  our  time  by  giving  attention  to  them  and  look- 
ing at  their  exhibits.  We  can  increase  the  ad- 
vertising in  our  Journal  by  telling  these  men  who 
furnish  the  advertising  that  we  patronize  them 
because  they  are  friends  of  the  Arkansas  Medical 
Society,  having  proven  so  by  their  advertising 
in  the  Journal. 


Gentlemen,  I want  to  thank  each  and  every 
member  of  the  various  committees  for  their  hearty 
support  and  co-operation  during  my  administra- 
tion the  past  year,  and  I want  to  say  in  behalf  of 
the  chairman  of  the  Council,  whose  report  you 
received,  that  he  was  ever  alert  and  fought  to 
the  last  ditch  to  have  the  fee  bill  as  adopted  by 
your  committee  approved.  But,  gentlemen,  as  I 
say,  when  you  have  eight  or  nine  hundred  mem- 
bers of  the  profession  in  the  society  out  of  a 
probable  total  of  two  thousand,  you  know  no  one 
is  going  to  listen  to  you. 

Now,  a great  many  men  will  say,  “Well,  what 
good  is  there  in  belonging  to  the  medical  so- 
ciety?” When  a large  insui'ance  company  wants 
a man  to  examine  for  them,  when  a large  indus- 
trial company  wants  a surgeon  or  a physician 
to  work  for  them,  or  a railroad  company,  they 
are  not  going  out  into  the  field  and  pick  a man 
who  doesn’t  believe  in  organized  medicine.  And 
you  wonder  why.  Because  the  legal  fraternity 
is  just  as  well  organized  as  any  body  of  men 
and  when  they  put  you  on  the  stand,  they  will 
ask  you,  “Dr.  Brown,  you  are  a graduate  of  what 
school?”  and  you  tell  him.  “Doctor,  you  prac- 
tice where?  How  long  have  you  been  practicing 
there?”  And  they  go  as  far  as  to  ask  you  your 
age,  and  I get  by  by  saying  that  I am  almost  as 
old  as  Texarkana,  because  I was  born  there,  and 
they  never  get  my  age.  Then  they  will  ask  you, 
“Doctor,  do  you  belong  to  your  county  medical 
society?”  You  say,  “No,  I don’t.”  “Well,  doc- 
tor, why  don’t  you  belong  to  your  medical  socie- 
ty?” “I  don’t  believe  in  it.”  Well,  now,  don’t 
think  for  a minute  that  that  lawyer  will  not  say 
to  the  jury,  “Gentlemen  of  the  jury,  the  defense 
has  Dr.  So-and-So  who  practices  medicine  in  this 
town  but  he  doesn’t  belong  to  the  medical  society 
because  he  doesn’t  believe  in  it.  Now,  gentlemen 
he  won’t  tell  you  the  truth  about  these  things. 
The  fact  is  that  he  doesn’t  belong  to  organized 
medicine  because  the  high-type  practitioner  who 
believes  in  organized  medicine,  who  believes  in 
medical  societies,  doubts  this  man’s  integrity, 
and  they  won’t  let  him  belong,  and  if  the  men 
who  know  his  qualifications  and  know  him  as  a 
man  can’t  believe  in  him,  how  can  the  members 
of  this  jury  believe  in  him.”  A great  many  of 
you  miay  differ  with  me  on  that  point  but  when 
you  stop  and  think  of  it  you  will  see  that  I am 
right. 

Now,  if  I have  neglected  my  duty  in  any  sense 
of  the  word,  it  has  been  of  the  mind  and  not  of 
the  heart.  The  friendships  I have  made  in  the 
past  year  will  linger  with  me  until  my  dying  day. 
And  I want  to  thank  each  and  every  one  of  the 
medical  profession  and  the  Auxiliary  for  their 
honest  co-operation  and  their  loyal  support  in 
the  past  year.  I thank  you.  (Applause.) 

Dr.  Gann:  The  House  of  Delegates 

appreciates  Dr.  Kosminsky’s  message. 


The  reports  of  the  standing  committees 
were  next  received. 


10 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  1 


SCIENTIFIC  PROGRAM 
R.  B.  Robins,  Chairman 

The  results  of  the  efforts  of  our  committee  are 
before  you  today,  tomorrow  and  the  next  day.  We 
hope  we  have  provided  a three-day  session  and 
program  here  that  will  meet  with  your  approval, 
both  scientifically  and  socially.  Your  committee 
began  work  on  this  program  immediately  after 
its  appointment  and  has  worked  diligently  all 
through  the  year  in  order  to  provide  something 
for  you  that  is  worth  while.  We  hope  we  have 
succeeded.  You  will  have  to  be  the  judge  of  that. 
It  is  the  opinion  of  this  committee,  and  we  would 
like  to  so  recommend,  that  the  papers  of  our  out- 
of-state  guests  not  be  open  for  general  discus- 
sion but  all  other  papers,  as  has  been  the  custom 
in  the  past,  will  be  open  for  general  discussion. 
Since  our  program  is  full,  we  believe  that  all  dis- 
cussions should  be  very  brief  and  to  the  point. 

We  want  to  thank  those  who  are  taking  part 
in  this  program  for  their  generous  contributions. 
I want  to  take  this  occasion  to  thank  the  other 
members  of  the  Program  Committee,  Drs.  Geo. 
F.  Jackson,  L.  H.  Lanier  and  W.  R.  Brooksher 
for  their  splendid  help  and  co-operation.  We 
have  enjoyed  serving.  I thank  you. 


SCIENTIFIC  EXHIBIT 
H.  Fay  H.  Jones,  Chairman 

We  have  tried  to  give  you  a good  exhibit  this 
year.  There  are  many  interesting  exhibits.  Dr. 
Kosminsky  said  awhile  ago  to  be  sure  and  stop 
and  encourage  the  men  by  showing  your  interest. 
One  man  said  he  had  an  exhibit  at  different  meet- 
ings and  had  never  seen  any  one  look  at  it.  I 
told  him  he  was  all  wet,  because  I looked  at  it 
myself  for  one,  and  knew  several  others  had. 

We  hope  you  will  enjoy  them.  The  men  on  the 
committee  with  me  have  given  me  loyal  and  help- 
ful support,  and  I am  very  glad  to  be  able  to 
do  my  part. 


REPORT  OF  THE  COMMITTEE  ON 
MEDICAL  LEGISLATION 

Mr.  President  and  members  of  the  House  of 
Delegates  of  the  Arkansas  Medical  Society: 

The  Committee  on  Medical  Legislation  met,  in 
response  to  the  call  of  the  chairman,  at  break- 
fast April  16th  to  consider  this  report  and  cer- 
tain recommendations  contained  herein.  Our 
President,  L.  J.  Kosminsky;  our  President-elect, 
F.  0.  Mahony;  our  Secretary,  W.  R.  Brooksher, 
and  our  Legal  Adviser,  Hon.  Peter  A.  Deisch, 
were  also  guests  of  the  chairman  at  this  meet- 
ing. There  were  several  extraordinary  sessions 
of  the  Legislature  since  our  last  meeting  but  no 
problems  of  consequence  to  the  medical  profes- 
sion were  considered  during  any  of  those  sessions 
except  the  small  percentage  of  tax  receipts  from 
beer  sales  allotted  to  the  Arkansas  Children’s 
Home  and  Hospital.  Therefore  there  has  been  no 
occasion  for  a previous  meeting  of  the  Committee 
on  Medical  Legislation. 


Nationally,  legislation  of  considerable  interest 
to  the  medical  profession  has  proceeded  to  a cli- 
max. The  bills  referred  to  concern  the  restora- 
tion of  benefits  to  veterans.  The  compromise 
bill  was  passed  by  both  Houses  of  Congress,  ve- 
toed by  the  President  and  repassed  over  the  veto, 
as  no  doubt  all  of  you  are  fully  aware.  The  chair- 
man of  this  committee  was  advised,  on  several 
occasions,  to  contact  our  representatives  in  Con- 
gress expressing  our  views  and  our  objections. 
The  chairman  immediately  got  in  touch  with  the 
members  of  this  committee,  members  of  the  Coun- 
cil as  well  as  officers  of  the  Society,  and  our  rep- 
resentatives in  Congress  were  flooded  with  tele- 
grams and  letters.  We  have  received  answers 
from  all  our  representatives  to  Congress  but  ap- 
parently politics  over-shadowed  the  better  judg- 
ment of  most  of  our  representatives  and  one  sen- 
ator to  the  extent  that  Congressman  Terry  and 
Senator  Robinson  were  the  only  votes  from  Ark- 
ansas sustaining  the  President’s  veto.  It  behooves 
all  of  us  to  remember  this. 

Several  bills  have  been  proposed  for  consider- 
ation in  the  forthcoming  regular  session  of  our 
state  Legislature  and  have  been  under  the  con- 
sideration of  this  committee  for  some  time.  The 
bills  referred  to  deal  with  workmen’s  compensa- 
tion laws,  restriction  of  the  indiscriminate  sale 
of  certain  somnifacient  and  sedative  preparations, 
administration  of  anesthetics  by  doctors  of  medi- 
cine only  and  certain  limitations  upon  legal  pro- 
cedure in  damage  suits  for  malpractice. 

Arkansas  is  one  of  the  three  states  not  having 
a workman’s  compensation  law.  Your  chairman 
is  in  the  midst  of  a study  of  various  laws  in  force 
and  some  that  have  been  proposed.  Your  com- 
mittee believes  that  such  a well-founded  law 
should  be  enacted. 

Several  states  have  a law  on  their  statutes  re- 
quiring prescriptions  signed  by  doctors  before 
certain  somnifacient  and  sedative  preparations 
may  be  dispensed.  A conference  recently  with  a 
group  of  representative  druggists,  who  officially 
represented  the  Little  Rock  Drug  Club,  on  this 
subject  convinced  us  that  the  druggists  of  Arkan- 
sas will  co-operate  heartily  in  the  passage  of  such 
an  act. 

The  committee  is  informed  that  only  four  states 
have  laws  concerning  the  ad  ministration  of  anes- 
thetics. The  proposed  bill  provides  that  only  those 
persons  holding  the  degree  of  Doctor  of  Medicine 
shall  administer  anesthetics  except  in  extreme 
emergencies  when  another  physician  is  not  avail- 
able for  that  purpose.  Other  minor  points  con- 
cerning the  administration  of  anesthetics  are  in- 
cluded in  the  proposed  bill.  It  is  estimated  that 
fully  50  per  cent  of  anesthetics  are  administered 
by  nurses,  undergraduates  and  others  who  are  not 
competent  as  physicians. 

A bill  has  been  proposed  for  limiting  the  time 
for  institution  of  a suit  for  damages  for  mal- 
practice to  one  year  following  the  alleged  act  of 
malpractice. 

No  doubt  the  new  committee  on  Medical  Legis- 
lation greatly  appreciates  hearing  from  members 
of  the  profession  on  these  proposed  measures. 
In  this  report  we  have  called  attention  to  a num- 


June,  1934] 


11 


ARKANSAS  MEDICAL  SOCIETY 


ber  of  existing  evils  that  should  be  corrected 
but  it  is  not  the  intention  of  this  committee  to 
initiate  all  subjects  considered  herein  in  the 
Legislature. 

This  committee  wishes  to  remind  the  profes- 
sion of  the  state  that  elections  will  soon  take 
place.  We  have  for  years  been  encouraging  the 
members  of  the  profession  to  become  politically 
minded  and  to  take  an  active  interest  in  elec- 
tions. Lack  of  concerted  action  and  preparation 
has  caused  us  many  anxious  hours.  You  will 
no  doubt  hear  more  on  this  subject  from  your  new 
committee  chairman. 

In  conclusion  we  desire  to  thank  our  president 
for  giving  us  this  opportunity  to  serve  the  Ark- 
ansas Medical  Society  during  the  past  year  in  the 
capacity  of  the  Committee  on  Medical  Legisla- 
tion. 

Respectfully  submitted, 

VAL  PARMLEY,  Chairman. 

M.  L.  NORWOOD. 

CHAS.  K.  TOWNSEND. 

R.  L.  ARMSTRONG. 

W.  T.  LOWE. 

J.  R.  PARKER. 

J.  G.  MARTINDALE. 


HEALTH  AND  PUBLIC  INSTRUCTION 
W.  B.  Grayson,  Chairman 

The  committee  on  Public  Health  desires  to  sub- 
mit the  following  report: 

Very  little  information  is  to  be  offered  from 
the  time  of  the  last  State  Medical  Meeting  until 
June  14th,  1933.  On  June  14th,  1933,  a new 
State  Health  Officer,  W.  B.  Grayson,  was  ap- 
pointed, succeeding  C.  W.  Garrison. 

The  new  State  Health  Officer  has  pledged  his 
co-operation  with  the  medical  profession  of  the 
state  and  has  inaugurated  three  policies  which 
the  State  Health  Department  is  endeavoring  to 
live  up  to,  i.  e. : 

(1)  That  the  personnel  of  the  State  Health 
Department  shall  not  practice  medicine  in  any 
form  or  fashion. 

(2)  The  discouragement  of  free  wholesale  im- 
munization clinics,  and 

(3)  The  discontinuance  of  free  wholesale  ton- 
sillectomy clinics,  unless  the  County  Society  de- 
sires to  put  on  such  a clinic.  The  State  Health 
Department  does  not  believe  in  this  type  of  clinic 
but  if  a County  Society  desires  to  put  one  on,  the 
State  Health  Department  will  co-operate  rather 
than  endeavor  to  stop  it. 

Due  to  financial  conditions,  the  appropriation 
for  the  state  Health  Department  was  cut  fifty- 
two  per  cent  by  the  1933  regular  session  of  the 
legislature,  resulting  in  reduction  of  the  personnel, 
with  the  abolishment  of  certain  field  offices.  It  has 
been  very  difficult  to  secure  funds  to  retain  the 
nursing  personnel;  however,  after  several  confer- 
ences, Federal  funds  were  obtained  to  supplement 
the  state  funds,  and  at  the  present  time  we  have 


at  least  a public  health  nurse  in  all  counties  but 
three.  The  funds  obtained  from  the  tax  on  in- 
surance policies  have  decreased  considerably  due 
to  so  many  people  allowing  their  insurance  poli- 
cies to  lapse.  This,  with  the  deplorable  financial 
condition  of  nearly  every  county  in  the  state,  has 
worked  a great  hardship  on  the  State  Health  De- 
partment in  keeping  the  nurses  in  the  field. 

We  are  endeavoring  to  our  utmost  to  keep  our 
nursing  activities  from  encroaching  upon  the 
rights  of  the  practitioners  of  the  state.  We  are 
co-operating  with  the  County  Medical  Societies 
in  the  assignment  and  activities  of  the  nurses. 
We  are  very  happy  to  report  that  at  this  time 
there  is  no  friction  between  the  State  Health  De- 
partment and  the  County  and  State  Medical  So- 
cieties. We  shall  always  encourage  the  reporting 
to  the  State  Health  Department  of  any  local  dif- 
ficulties which  might  arise  between  organized 
medicine  and  public  health. 

A summary  of  communicable  diseases  preval- 
ent in  the  state  since  June,  1933,  might  be  listed 
as  follows: 

We  are  glad  to  report  that  during  the  serious 
outbreak  of  encephalitis  in  St.  Louis  during  the 
summer  and  fall  of  1933,  only  three  or  four  defi- 
nitely diagnosed  cases  were  found  in  our  state. 

There  seems  to  be  much  more  malaria  in  the 
state  this  year  than  in  the  past  several  years, 
probably  due  to  many  factors,  such  as  lack  of 
screening  and  repairing  of  screens,  inability  to 
properly  drain  or  oil  stagnant  ponds  of  water, 
and  the  low  financial  condition  of  many  of  our 
people,  making  it  impossible  to  purchase  quinine 
for  preventive  measures. 

During  the  months  of  December  and  January 
a rather  serious  outbreak  of  epidemic  cerebro- 
spinal meningitis  occurred  at  the  Tucker  Prison 
Farm.  There  were  eleven  cases  in  all,  with  seven 
deaths.  Considering  the  exceedingly  crowded 
condition  of  the  stockades  in  the  two  camps  in 
which  this  outbreak  occurred,  we  feel  that,  with 
only  seven  deaths,  good  work  was  done  in  stamp- 
ing out  this  disease.  The  United  States  Public 
Health  Service  co-operated  by  sending  an  epidemi- 
ologist to  help  and  to  study  the  situation.  We 
are  sorry  that  no  new  information  was  obtained 
regarding  this  disease  by  the  study  of  this  out- 
break. 

In  two  or  three  schools  of  the  state  a rather 
serious  outbreak  of  diphtheria  occurred;  however, 
no  great  number  of  deaths  from  this  disease  were 
reported  to  the  office  of  Vital  Statistics.  The  new 
prophylaxis  by  the  Alum  Precipitate  Toxoid  makes 
it  easier  to  inoculate  more  individuals,  especially 
children,  by  the  one  dose  method. 

Scarlet  fever  epidemics  were  about  as  usual  over 
the  state,  and  although  it  is  known  that  one  state 
health  department  is  using  a prophylactic  serum 
for  scarlet  fever,  which  requires  five  modula- 
tions, the  State  Health  Department  of  Arkansas 
does  not  encourage  this  method  of  prophylaxis  in 
scarlet  fever  for  the  reason  that  so  many  separate 
inoculations  make  it  rather  difficult  of  perform- 
ance. And  also,  the  period  of  immunity  is  indefi- 
ite,  probably  lasting  only  about  one  year. 


12 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  1 


There  has  been  an  unusual  outbreak  of  measles 
over  the  state,  and  the  latest  authorities  have  not 
thrown  any  new  light  on  the  subject  in  regard  to 
prevalence  or  treatment.  It  is  definitely  known 
that  the  incubation  period  is  fourteen  days  in 
measles,  and  it  has  been  proven  that  the  last 
three  or  four  days  of  this  incubation  period  is 
really  the  period  of  invasion. 

In  November  the  United  States  Health  Service 
and  the  State  Health  Department,  in  co-operation 
with  the  Civil  Works  Administration,  instituted  a 
state-wide  sanitation  program  for  the  construction 
of  sanitary  pit  privies,  and  also  a malaria  control 
program  for  the  malarial  section  of  the  state.  The 
combined  programs  e ir ployed  about  five  thousand 
five  hundred  men,  and  the  general  reaction  of  the 
people  of  our  state  would  indicate  that  it  was 
favorably  accepted  by  everyone.  Over  one  thou- 
sand miles  of  shallow  drainage  ditches  were  com- 
pleted in  the  malaria  control  program  and  close 
to  sixteen  thousand  sanitary  privies  were  con- 
structed in  the  Sanitation  Program.  Efforts  were 
made  to  include  screening  of  houses  and  also  lab- 
oratory procedure  in  the  malarial  control  pro- 
gram, but  this  was  consistently  refused  by 
authorities  at  Washington. 

Over  two  hundred  fifty  unemployed  graduate, 
nurses  were  assigned  through  the  State  Health 
Department,  in  co-operation  with  the  Civil  Works 
Service,  to  assist  our  regular  county  health  nurs- 
es and  to  do  child  hygiene  at  various  schools  over 
the  state,  as  well  as  to  conduct  home  hygiene 
classes  in  various  counties. 

Public  health  work  in  this  state  has  made  fav- 
orable progress  according  to  reports  from  the 
United  States  Public  Health  Service  and  from 
the  Rockefeller  Foundation.  No  funds  have  been 
allotted  by  the  Rosenwald  Foundation  during  this 
period. 

The  Public  Health  Service  has  rendered  invalu- 
able aid  to  cities  and  communities  in  approving 
and  helping  several  cities  to  secure  sewerage  and 
water  disposal  plants  or  repairs,  and  extension  of 
present  water  sewerage  through  co-operation  of 
the  Public  Works  Administration. 

There  has  been  no  law  in  this  state  regarding 
the  licensure  of  midwives.  The  State  Health  De- 
partment regulates  the  practice  of  midwifery  in 
this  state,  and  in  a great  many  instances  permits 
were  refused  due  to  the  fact  that  the  applicant 
did  not  have  the  approval  of  the  physicians  in 
her  community.  Every  effort  will  be  made  to 
keep  this  practice  within  bounds  according  to  the 
particular  counties. 

W.  B.  GRAYSON.  Chairman. 
J.  F.  WILLIAMS. 

F.  O.  ROGERS. 

PAUL  MAHONEY. 

J.  D.  RILEY. 

A.  S.  BUCHANAN. 


REPORT  OF  CREDENTIALS  COMMITTEE 

Dr.  Shuffield:  I wish  to  announce  that  the  com- 
mittee has  carefully  checked  the  card  registra- 
tions against  the  records  and  the  credentials,  and 
while  quite  a number  are  absent,  those  present 
have  been  duly  qualified. 


CANCER  CONTROL 
W.  Decker  Smith,  Chairman 

Mr.  President  and  Members  of  the  House  of  Dele- 
gates : 

Your  Committee  on  Cancer  control  followed  dur- 
ing the  past  year  a definite  policy  arranged  in 
conjunction  with  the  American  Society  for  the 
Control  of  Cancer. 

Heretofore  this  committee  has  set  aside  a week 
to  be  devoted  to  cancer  control.  The  committee 
and  representatives  of  the  National  Society  on 
the  control  of  this  disease  believe  that  this  im- 
portant subject  requires  a continued  program,  ex- 
tending through  the  entire  year.  A definite  five- 
year  program  has  been  formulated  in  which  the 
committee  hopes  to  accomplish  something  defi- 
nite in  the  early  recognition  and  treatment  of  the 
disease. 

Realizing  the  fact  that  the  family  physician  is 
the  key-man  in  cancer  control,  our  object  is  to 
create  a yearly  symposium  in  each  component 
part  of  the  state  medical  society  to  stimulate 
greater  interest  in  study,  control  and  cure  of 
cancer.  This  year  a symposium  of  tumors  of  the 
uterus  is  being  followed  and  a large  number  of 
the  county  and  district  medical  societies  have  re- 
sponded with  medical  and  surgical  papers  on  this 
subject.  This  society  through  the  courtesy  of  the 
American  Society  for  the  Control  of  Cancer,  has 
available  moving  picture  films,  lantern  slides  and 
medical  papers  for  use  by  the  various  county  and 
district  medical  societies  in  their  programs.  These 
films  and  slides  are  deposited  with  the  University 
of  Arkansas  Medical  School  and  can  be  obtained 
by  either  writing  to  the  chairman  of  the  Cancer 
Control  Committee  or  H.  S.  Thatcher  of  the  Medi- 
cal School. 

The  Canti  film  and  various  medical  pamphlets 
for  distribution  have  also  been  made  available  to 
the  state  society  to  be  used  in  public  health  and 
lay  meetings  and  have  been  used  by  some  of  the 
county  and  district  societies  during  the  past  year. 

An  interest  in  this  subject  must  be  created  in 
the  mind  of  the  laymen  so  they  may  realize  that 
the  disease  is  curable  in  its  early  stages.  They 
must  be  acquainted  with  the  early  symptoms  and 
the  importance  of  frequent  periodic  examinations 
by  their  family  physician  of  all  suspicious  les- 
ions. For  this  purpose  a series  of  newspaper 
articles  have  been  prepared  by  national  authori- 
ties on  the  disease  and  which  have  been  censored 
by  your  Committee  on  Publicity.  These  articles 
are  to  appear  in  various  newspapers  of  the  state 
in  the  near  future. 

In  regard  to  newspaper  publicity,  there  has 
been  some  difficulty  in  obtaining  the  co-opera- 
tion of  newspapers  with  large  distribution.  I 
speak  particularly  of  the  Arkansas  Gazette  which 
has  refused  to  publish  such  articles  because  of  the 
fact  that  the  managing  editor  “does  not  feel  that 
sufficient  interest  will  be  aroused  by  the  articles 
to  justify  their  publication.”  It  appears  to  me, 
personally,  that  this  is  not  the  proper  attitude 
for  one  of  our  largest  state  institutions  to  take, 
especially  when  it  is  a public  health  measure 
aimed  at  the  improvement  of  one  of  the  most 


June,  1934] 


ARKANSAS  MEDICAL  SOCIETY 


13 


dreaded  and  destructive  diseases  with  which  the 
human  race  is  afflicted. 

We  are  trying  to  have  established,  definite 
courses  pertaining  to  all  phases  of  cancer  in  the 
nurses’  training  schools  in  the  various  hospitals 
of  the  state,  and  text  books  for  instructions  in 
this  disease  have  been  furnished  to  the  respective 
superintendents. 

A recent  communication  from  the  managing 
director  of  the  American  Society  for  the  Control 
informs  your  committee  that  due  to  curtailed  fi- 
nancial support  of  their  organization,  it  will  be 
handicapped  during  the  coming  year.  It  seems 
likely  that  the  national  societies  will  have  to 
make  a nomimal  charge  for  literature  and  for 
the  preparation  of  material  for  next  year’s  pro- 
gram. They  are  asking  for  donations  from  our 
state  in  the  amount  of  $500.00  in  order  that  this 
important  program  may  be  continued.  Just  how 
this  money  is  to  be  raised  is  not  quite  clear  to 
your  committee,  but  we  feel  that  sufficient  in- 
terest should  be  obtained  in  our  state  to  raise  the 
amount  asked  for  the  continuation  of  this  work. 

In  conclusion,  I wish  to  thank  the  other  mem- 
bers of  the  committee  for  their  help  and  also  Dr. 
Cox,  Southern  Field  Representative  and  his  staff 
of  the  American  Society  for  the  Control  of  Can- 
cer, who  have  been  very  helpful  at  all  times  with 
the  program  sponsored  by  our  medical  society. 

W/DECKER  SMITH,  Chairman. 
D.  W.  GOLDSTEIN. 

B.  E.  HENDRIX. 

L.  A.  PURIFOY. 

CHAS.  S.  HOLT. 


CONSTITUTION  AND  BY-LAWS 
D.  A.  Rhinehart,  Chairman 

Dr.  Rhinehart:  The  Committee  on  Constitution 
and  By-Laws  calls  attention  to  the  constitutional 
changes  that  have  been  printed  on  page  11  of 
the  program1.  These  were  presented  and  read  at 
the  last  annual  session.  The  constitution  pro- 
vides that  they  be  held  over  for  a year  and  pub- 
lished twice  during  the  year,  which  has  been  done, 
and  brought  up  for  final  adoption  at  the  succeed- 
ing meeting.  Is  it  the  pleasure  of  the  House  of 
Delegates  that  these  changes  be  taken  up  one  at 
a time,  read  and  adopted  singly,  or  would  you 
prefer  to  have  them  all  adopted  as  a whole? 

By  motion  the  amendments  were  adopted  as  a 
whole. 


PUBLICITY 

Jerome  S.  Levy,  Chairman 

The  Committee  on  Publicity  met  at  the  Albert 
Pike  Hotel  on  March  1st,  1934.  Dr.  D.  A.  Rhine- 
hart met  with  us  as  our  guest.  Your  committee 
discussed  various  pubHcity  features  with  a view 
to  a campaign  for  medical  education  of  the  public. 

The  rapidity  of  changes  for  the  past  few  years 
has  taught  American  people  to  think  more  ac- 
tively about  government  affairs.  This  has  stimu- 


lated the  minds  of  the  people  and  has  made  them 
aware  of  the  need  of  progressive  views.  It  is 
fitting  that  at  this  time  the  medical  profession 
should  be  “actionary,”  rather  than  “reactionary” 
and  wage  an  intensive  campaign  to  inform  the 
public  of  the  great  progress  which  has  charac- 
terized our  profession  during  the  last  decade.  We 
have  left  it  to  the  newspapers  in  their  quest  for 
news  to  publish  whatever  new  discoveries  have 
stood  the  test  of  research  and  clinical  experience. 
We  have  also  half-heartedly  answered  criticisms 
of  our  medical  economics.  Press  dispatches  head- 
lined the  accusation  that  “Doctors  Were  Plumb- 
ers” and  that  “Some  40  per  cent  to  60  per  cent  of 
Appendectomies  are  Unnecessary.”  However, 
Doctor  Dean  Lewis’  answer  was  given  but  little 
space.  We  owe  it  to  ourselves  to  adopt  a plan 
of  publicity  which  would  eliminate  such  occurren- 
ces whose  aftermaths  are  so  potentially  danger- 
ous. With  this  in  mind  your  committee  makes 
the  following  recommendations: 

1.  That  the  Arkansas  Medical  Society  carry  on 
an  intensive  publicity  plan  under  the  direction  of 
a committee  on  publicity. 

(a)  That  this  plan  encompass  articles  and 
speeches  on  medical  progress,  medical  subjects  of 
general  interest,  dissemination  of  the  principles 
of  preventive  medicine,  and  to  explain  the  im- 
portance of  the  maintenance  of  high  ethical  stand- 
ards. 

2.  This  program  to  be  carried  out  by  several 
methods,  each  of  which  may  be  used. 

(a)  The  first  method  is  utilization  of  the  news- 
papers for  short  concise  articles  written  by  va- 
rious members  at  the  request  of  the  committee 
and  distributed  by  the  committee.  These  should 
be  given  out  as  under  the  auspices  of  the  com- 
mittee on  publicity  of  the  Arkansas  Medical  So- 
ciety. They  should  be  written  under  a definite 
plan  and  released  for  publication  in  accordance 
with  the  workings  of  this  plan.  The  committee 
has  choice  of  one  of  several  methods  of  release, 
namely:  through  each  county  society  whose  re- 
sponsibility will  be  to  place  them  in  the  respec- 
tive county  newspapers ; for  the  committee  to  send 
them  direct  to  the  newspapers  or  syndicate  them 
through  the  Western  Newspaper  Union  or  some 
similar  agencies.  The  committee  feels  that  ad- 
vertisements in  the  papers  and  over  radio  broad- 
casts are  too  costly  at  this  time  for  the  medical 
society’s  finances. 

(b)  The  second  method  is  through  the  effective 
working  of  a Speaker’s  Bureau.  The  committee 
had  in  mind  the  organization  of  a State  Speaker’s 
Bureau.  This  would  be  composed  of  physicians 
selected  by  the  committee  because  of  their  ability 
as  speakers  as  well  as  for  their  medical  knowl- 
edge. They  would  be  used  as  a nucleus  of  a lar- 
ger body  which  would  be  formed  as  the  plan  be- 
comes workable.  These  men  would  be  asked  to 
prepare  talks  of  various  lengths  on  specified  sub- 
jects and  to  hold  themselves  in  readiness  to  ap- 
pear on  a week’s  notice  before  various  civic  clubs; 
Parent-Teacher  Associations,  school  assemblies  or 
public  programs  of  various  sorts.  Your  commit- 
tee would  then  be  in  position  to  notify  the  secre- 
tary or  president  of  a given  organization,  say  a 


14 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  1 


PTA,  that  it  was  prepared  to  give  a series  of 
talks  on  health  subjects  of  particular  value  to  the 
parents  and  teachers  of  the  school  child.  The 
committee  could  also  notify  a given  civic  club 
that  a capable  speaker  with  an  important  civic 
message  on  health  was  available  to  address  that 
club.  We  would  thus  be  able  to  build  uip  a public 
confidence  which  our  silence  has  strained.  These 
speakers,  of  course,  could  be  exchanged  between 
counties  as  we  well  know  a “prophet  is  without 
honor  in  his  own  county.” 

JEROME  S.  LEVY,  Chairman. 

S.  J.  HESTERLY. 

EARLE  H.  HUNT. 

F.  E.  BAKER. 

E.  L.  BECK. 


CHILD  WELFARE 
S.  A.  Drennen,  Chairman. 

To  the  Fifty-Ninth  Annual  Session  of  the  Arkan- 
sas Medical  Society: 

We,  your  committee  on  Child  Welfare,  beg  to 
report  the  following: 

In  so  far  as  the  committee  has  been  able  to 
ascertain  from  investigation  there  has  not  been 
any  definite  program  outlined  by  the  Arkansas 
Medical  Society  pertaining  to  Child  Welfare. 

The  problem  of  child  welfare  to  our  organiza- 
tion is  only  that  of  looking  after  the  physical 
and  mental  condition  of  the  child.  And,  as  we 
are  all  aware  these  conditions  have  been  met  by 
the  individual  practitioner.  Your  committee  has 
investigated  the  programs  of  other  organizations 
pertaining  to  child  welfare  and  have  found  some 
rather  interesting  statistics.  It  would  be  most 
surprising  to  this  organization  to  know  the  num- 
ber of  handicapped  children  in  twenty-three  coun- 
ties of  this  state  which  were  surveyed  by  the 
child  welfare  department  of  the  American  Legion 
and  the  available  statistics  of  our  Public  Health 
Department  are  also  very  interesting. 

Time  will  not  permit  us  to  go  into  statistics 
in  regard  to  the  different  kind  and  numbers  of 
handicaps  but  suffice  it  to  say.  that  they  are  in 
greater  numbers  than  even  we  of  the  medical  pro- 
fession are  led  to  believe.  Your  committee  be- 
lieves from  a thorough  study  of  this  subject  that 
it  is  too  large  for  one  single  organization  to  at- 
tack, and  that  if  the  handicapped  children  of  this 
state  are  to  receive  what  they  are  justly  entitled 
to  it  will  only  be  through  a concerted  effort  of 
all  organizations  having  to  do  with  this  particu- 
lar subject.  As  you  know  there  are  a great  num- 
ber of  the  different  organizations  having  their 
child  welfare  departments  and  we  are  quick  to 
admit  that  they  have  done  and  are  doing  their 
very  best  which  we  know  is  very  little.  We  be- 
lieve the  moneys  that  these  departments  have  and 
are  expending  in  this  field  could  be  handled  by 
one  particular  organization  we  would  get  some- 
where and  in  conclusion  your  committee  would 
strongly  recommend  the  endorsing  by  the  Arkan- 


sas Medical  Society  a department  to  be  created 
by  the  General  Assembly  of  this  state  to  be  known 
as  the  Department  of  Public  Welfare.  Investiga- 
tion of  the  same  departments  of  other  states  leads 
your  committee  to  believe  that  this  would  be  a 
happy  solution  to  this  perplexing  problem. 

Respectfully  submitted, 

S.  A.  DRENNEN,  Chairman. 


DISEASES  OF  THE  HEART 
A.  G.  Sullivan,  Chairman. 

To  the  President  and  Members  of  the  House  of 

Delegates: 

The  death  rate  from  heart  disease  in  Arkansas 
in  1932  (the  latest  year  for  which  statistics  are 
available)  was  99.6  per  100,000  population.  This 
rate  was  the  lowest  of  any  state  in  the  Union 
and  compares  very  favorably  with  the  highest 
rate,  that  of  323  in  New  Hampshire,  and  with  a 
rate  of  224  for  the  United  States,  as  a whole. 
Whereas  for  the  United  States  as  a whole,  the 
mortality  rate  from  heart  disease  increased  from 
214  to  224  per  100,000  popu'ation,  from  1930  to 
1932;  the  Arkansas  rate  declined  from  a peak  of 
117  in  1930  to  99  in  1932.  It  might  be  added  that 
in  1932  in  death  rates  from  all  causes,  Arkansas 
ranked  4th  from  lowest  in  the-  United  States  with 
the  gratifying  low  rate  of  873.9  per  100,000  popu- 
lation. 

Despite  this  improvement,  however,  heart  dis- 
ease is  still  causing  far  more  deaths  in  Arkan- 
sas than  any  other  agency.  There  is  at  present 
no  way  of  breaking  down  these  statistics  in  order 
to  obtain  information  as  to  the  etiological  fac- 
tors involved.  Even  though  physicians  follow 
closely  the  International  List  of  Causes  of  Death 
in  making  out  death  certificates  there  is  still  a 
great  deficiency  in  this  respect.  The  list  was  re- 
vised in  1930  and  includes  under  general  classifi- 
cation “Heart  Disease”  the  sub-headings: 

Pericarditis, 

Acute  endocarditis, 

Chronic  endocarditis,  valvular  diseases, 

Diseases  of  the  myocardium, 

Diseases  of  the  coronary  arteries  and  angina 
pectoris,  and 

Other  diseases  of  the  heart. 

Unfortunately  for  any  purpose  of  analysis  about 
88  per  cent  of  all  deaths  attributed  to  the  general 
classification  of  heart  disease  are  listed  under 
the  heading  “other  diseases  of  the  heart,”  or  just 
“heart  diseases.”  A survey  is  being  undertaken 
by  your  committee  among  several  men  in  the  state 
particularly  interested  in  heart  disease  to  deter- 
mine what  etiological  factors  are  most  prominent. 
That  is,  what  percentage  of  heart  disease  in  their 
private,  clinic  and  hospital  practice  is  attributed 
to  rheumatism,  syphilis,  arteriosclerosis,  hyper- 
tension, etc.  By  applying  these  morbidity  figures 
among  the  native  white  population  to  the  mortal- 


June,  1934] 


ARKANSAS  MEDICAL  SOCIETY 


15 


ity  statistics  it  is  hoped  that  a clearer  picture  of 
heart  disease  in  the  state  of  Arkansas  may  be 
presented  to  the  medical  profession. 

A.  G.  SULLIVAN,  Chairman. 

O.  C.  MELSON. 

A.  W.  STRAUSS. 

W.  H.  BRUCE. 

R.  C.  DICKINSON. 

P.  H.  PHILLIPS. 


REPORT  OF  THE  COUNCIL 
M.  E.  McCaskill,  Chairman 

The  past  year,  in  so  far  as  the  activities  of  the 
Council  were  concerned  was  very  unhappy  and 
disappointing. 

The  death  of  Dr.  W.  R.  Bathurst,  the  secretary 
and  editor  of  the  Journal  was  a profound  shock 
to  all  of  us  and  it  was  with  the  realization  of 
our  great  responsibility  that  we  set  about  to  se- 
lect a successor  to  serve  until  this  meeting.  For- 
tunately, there  was  available  Dr.  W.  R.  Brook- 
sher,  in  whom  we  have  the  utmost  confidence, 
and  it  was  our  pleasure  to  select  him. 

The  various  Councilor  District  Medical  Socie- 
ties are  thriving  and  it  is  believed  they  will  con- 
tinue to  grow  from  year  to  year  and  function  in 
a sphere  that  is  beyond  either  the  county  or  state 
society. 

Since  August  of  last  year  the  Council  has  had 
its  various  regular,  special  and  committee  meet- 
ings, as  well  as  by  correspondence  participated 
in  a fight  with  the  administrator  of  Federal  re- 
lief for  a fair  fee  schedule  for  the  doctors  who 
were  called  upon  to  render  medical  aid  to  those 
indigent  persons  who  were  being  cared  for  by 
the  government.  The  matter  was  considered  of 
such  great  importance  and  the  fee  schedule  which 
had  been  thrust  upon  us  so  unfair  and  unreas- 
onable that  a spirited  effort  was  made  to  secure 
a revision.  The  organized  medical  group  was  not 
consulted  and  there  was  no  agreement  between 
the  state  administrator  and  the  society  as  therb 
should  have  been,  had  the  law  been  carried  out 
as  it  was  written.  We  continued  our  efforts  un- 
til at  the  meeting  on  March  21st  last,  we  were 
advised  by  the  state  administrator  that  under  the 
new  relief  set-up,  to  be  in  effect  on  April  1st, 
medical  relief  would  be  discontinued. 

It  is  to  be  hoped  that  each  and  every  member 
of  this  society  and  each  component  society,  will 
not  forget  that  the  schedule  was  forced  upon  us 
by  an  unsympathetic  state  politician  and  never 
at  any  time  did  we  agree  to  accept  it,  nor  recom- 
mend to  the  members  that  it  was  fair;  especially, 
since  it  cared  for  only  a part  of  our  charity  load 
and  that  on  a very  inadequate  basis.  To  work 
under  the  schedule  a physician  had  to  either  ren- 
der inferior  service  or  pay  for  the  privilege  of 
having  charity  patients  referred  to  him. 

Let  us  accept  this  experience  as  a lesson  never 
to  be  forgotten,  that  the  so-called  state  medicine 
would  be  a mortal  blow  to  the  art  of  the  practice 
of  medicine  as  we  now  know  it  and  of  which  we 
are  so  proud. 

M.  E.  McCASKILL,  Chairman. 


HOSPITALS 
W.  F.  Smith,  Chairman 

To  the  Members  of  the  House  of  Delegates: 

Hospital  standardization  has  had  for  its  funda- 
mental idea  throughout  its  sixteen  years  of  ex- 
istence improvement  in  the  care  of  the  sick  and 
injured  and  has  resulted  in  a direct  benefit  to 
all  classes. 

The  improvement  in  hospital  equipment  and 
service,  the  raising  of  the  standard  of  the  medi- 
cal and  surgical  staff  so  that  only  full  graduates 
of  medicine,  licensed  and  in  good  standing,  com- 
petent in  their  respective  branches  and  of  good 
moral  character  be  permitted  to  treat  patients, 
has  brought  about  far-reaching  results. 

In  a properly  organized  and  conducted  hospital 
it  is  essential  that  there  be  a well-functioning 
staff,  either  closed  or  open,  which  will  meet  at 
regular  intervals  to  review  and  analyze  the  work 
in  the  hospital.  Complete  histories  must  be  pre- 
pared with  a working  and  a final  diagnosis,  there 
should  also  be  a clinical  and  X-ray  laboratory 
provided,  or  at  least  be  available.  In  1918,  only 
eighty-nine  hospitals  in  the  United  States  could 
meet  the  requirements,  today  2,384  are  meeting 
thern,  which  shows  a commendable  progress. 
Twelve  and  nine-tenths  per  cent  met  the  require- 
ments in  1918,  while  today  67  per  cent  are  ap- 
proved. It  is  urged  that  the  importance  of  regu- 
lar staff  conferences  be  not  overlooked  as  these 
^meetings  will  result  in  much  good,  not  the  least 
of  which  is  the  co-operation  and  good  fellowship 
which  always  should,  but  many  times  does  not, 
prevail. 

The  status  of  the  case  record  has  been  much 
discussed.  It  is  generally  accepted  that  the  pa- 
tient has  the  right  to  the  use  of  his  record  and 
that  no  person  has  the  right  to  access  except  by 
his  specific  orders.  The  consent  of  the  attend- 
ing physician  should  be  secured  when  possible.  In 
any  review  or  analysis  of  cases  the  identity  of 
the  patient  should  not  be  revealed,  and  the  hos- 
pital should  not  exhibit  the  record  without  a 
subpoena  from  a court. 

The  laity  has  for  some  time  realized  that  ob- 
stetrical service  should  be  had  in  a well-equipped 
hospital.  In  the  most  of  our  hospitals  the  physi- 
cal equipment  for  the  care  of  maternity  cases  is 
adequate,  this  equipment  providing  for  the  segre- 
gation of  obstetrical  from  other  patients  and 
nurses  who  care  exclusively  for  these  patients 
are  provided.  There  should  be  a new-born  nur- 
sery with  isolation  provided  when  required.  This 
should  also  be  true  of  the  delivery  room,  which 
should  never  be  in  any  way  associated  with  the 
general  operating  room.  Records  should  be  ac- 
curately kept,  especially  of  the  new-born.  Ma- 
ternity mortality  has  not  decreased  in  the  United 
States  during  the  last  thirty  years  and  the  greater 
part  of  this  maternal  mortality  is  preventable. 
This  is  our  excuse  to  stress  the  great  necessity 
for  those  in  charge  of  our  hospitals  to  make  and 
enforce  the  strictest  of  regulations  for  their  ob- 
stetrical practice.  A hospital  should,  and  can 
be  the  safest  place  for  the  expectant  mother. 


16 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  1 


We  feel  that  much  is  yet  to  be  accomplished 
in  the  field  of  cancer  control.  How  this  can  be 
brought  about  is  a question  we  are  not  prepared 
to  answer.  It  is  suggested,  however,  that  the 
doctors  who  are  interested  in  this  work  might 
devise  some  plan  whereby  the  supply  of  radium 
could  be  pooled  and  made  available  when  mas- 
sive exposure  is  indicated.  We  find  that  many 
of  our  hospitals  have  been  earnestly  striving  and 
succeeding  in  improving  their  facilities  and  con- 
ditions. 

According  to  the  Hospital  Standardization  Re- 
port of  the  American  College  of  Surgeons  for 
1933,  we  find  the  following  concerning  Arkansas 
Hospitals. 

Total  Number  of  Hospitals  Approved 20 

Fully  Approved  17 

Provisionally  Approved  3 

Percentage  of  Hospitals  Fully  and  Pro- 
visionally Approved  57.1% 

As  to  bed  capacities  the  following  is  shown: 

Fully  Provisionally  Not 
Approved.  Approved.  Approved 

25  to  49  beds 1 0 10 

50  to  99  beds 5 3 4 

100  and  over  beds 110  1 

The  1934  survey  is  under  way  but  is  not  as  yet 
complete.  Thirty-five  hospitals  are  under  sur- 
vey but  it  is  not  known  how  many  additional  hos- 
pitals have  been  put  on  the  list.  It  is  known, 
however,  that  one  hospital,  a Little  Rock  institu- 
tion, is  still  off  the  approved  list  after  having 
been  on  for  several  years. 


rather  expensive.  The  treasurer’s  report,  how- 
ever, showed  a cash  balance  of  over  $90,000. 

Our  president,  Dr.  Kosminsky,  was  also  present 
and,  upon  invitation,  made  a fine  talk. 

I had  the  pleasure  of  attending  the  meeting  of 
the  Texas  Railway  Surgeons,  an  adjunct  of  the 
Texas  Medical  Society.  Many  subjects  of  interest 
were  discussed.  The  formation  of  a similar  ad- 
junct to  the  Arkansas  Medical  Society  is  urged 
for  your  consideration. 

The  last  event  of  the  day  was  a barbecue  din- 
ner at  the  beautiful  country  estate  of  a hospitable 
Texan  whose  vocation  is  the  production  of  oil, 
his  avocation  being  the  practice  of  medicine  in 
Fort  Worth. 

W.  F.  SMITH. 


REPORT  OF  THE  STATE  BOARD  OF 
MEDICAL  EXAMINERS 

The  State  Medical  Board  of  the  Arkansas  Medi- 
cal Society  has  held  four  meetings  since  last  April. 
There  was  only  one  new  member  appointed  dur- 
ing the  past  year,  L.  T.  Evans,  Batesville,  suc- 
ceeding Sam  J.  Allbright,  Searcy,  whose  term  ex- 
pired. A special  meeting  was  called  on  June  19, 
1933,  for  the  purpose  of  re-organizing,  and  the 
following  officers  were  elected:  W.  W.  York,  pres- 
ident;, Ashdown;  W.  T.  Lowe,  vice-president,  Pine 
Bluff,  and  A.  S.  Buchanan,  secretary-treasurer, 
Prescott.  Wm.  A.  Snodgrass,  Little  Rock,  W.  T. 
Lowe,  and  the  secretary  were  named  the  com- 
mittee on  schools  and  reciprocity. 


Your  committee  feels  that  progress  is  being 
made  in  the  equipment  and  operation  of  our  hos- 
pitals. 

W.  F.  SMITH,  Chairman. 

M.  J.  KILBURY. 

W.  G.  HODGES. 

R.  L.  SMITH. 


FRATERNAL  DELEGATE 
To  the  Members  of  the  House  of  Delegates: 

Through  the  kindness  of  President  L.  J.  Kos- 
minsky I was  honored  by  being  designated  the 
fraternal  delegate  from  the  • Arkansas  Medical 
Society  to  the  Texas  Medical  Society  which  met 
at  Fort  Worth  in  May  1933. 

From  the  time  I presented  my  credentials  to 
Dr.  Holman  Taylor,  the  genial  secretary  of  the 
Texas  Medical  Society,  to  the  time  I boarded  the 
train  for  Little  Rock  I was  the  recipient  of  cour- 
teous and  spontaneous  hospitality. 

I attended  the  meeting  of  the  House  of  Dele- 
gates and  extended  the  fraternal  greetings  of 
our  society.  An  expression  of  reciprocal  good 
will  was  quickly  forthcoming. 


The  following  list  contains  the  entire  member- 
ship of  the  Board  at  the  present  time  and  in- 
formation regarding  each  member’s  term,  date  of 
appointment  and  date  of  expiration  of  his  present 
term: 

NAME  Term.  App’d.  Exp. 


W.  W.  York,  President, 

Ashdown  Second 

W.  T.  Lowe,  Vice-President, 

Pine  Bluff Second 

A.  S.  Buchanan,  Secretary-Tres- 

urer,  Prescott  Second 

Wm'.  A.  Snodgrass,  Little  Rock  ..  First 
W.  H.  Mock,  Prairie  Grove.  ..  Second 

W.  W.  Verser,  Harrisburg  ... Second 

L.  T.  Evans,  Batesville Fmst 


1931  1935 

1933  1937 

1933  1937 
1931  1935 
1933  1937 
1931  1935 
1933  1937 


There  have  been  several  difficult  and  unpleas- 
ant problems  brought  before  us  for  disposal.  In 
our  official  acts  pertaining  to  these  cases  it  has 
been  our  endeavor  to  administer  the  law  with  im- 
partial fairness  to  all  concerned,  and  yet  we  have 
tried  to  carry  out  what  we  believed  to  be  the  de- 
sires of  this  society  as  expressed  in  the  statues. 
We  have  also  tried  to  maintain  the  present  stand- 
ard of  medical  education  and  licensure  which  is 
recognized  by  the  American  Medical  Association. 


I was  particularly  impressed  with  the  manner 
in  which  their  meeting  was  conducted.  The  pro- 
gram of  the  proceedings  and  the  report  of  the 
chairman  of  each  committee  was  printed  in  a 
neat  volume.  These  reports  were  at  times  quite 
voluminous  and  the  compilation  must  have  been 


Before  an  applicant  is  granted  a license  by  rec- 
iprocity or  before  an  applicant  is  permitted  to 
appear  before  the  Board  of  examination  he  must 
produce  satisfactory  credentials  proving  his  char- 
acter and  qualifications.  These  credentials  al- 
ways receive  our  utmost  scrutiny.  In  connection 


June,  1934] 


ARKANSAS  MEDICAL  SOCIETY 


17 


with  this  statement  I wish  to  take  this  opportun- 
ity of  passing  a bit  of  personal  comment  upon 
the  work  of  the  Basic  Science  Board.  It  is  my 
own  personal  opinion  that  the  enactment  of  the 
Basic  Science  Law  in  this  state  has  been  a great 
asset  and  a safeguard  for  the  medical  profession 
and  the  people  of  Arkansas.  Through  the  pro- 
visions of  this  act  it  is  almost  impossible  for  a 
candidate  to  secure  license  for  any  purpose  other 
than  that  of  engaging  in  a worthy  and  legitimate 
practice. 

Two  licentiates  were  cited  for  trial  before  the 
Board  because  they  had  been  convicted  of  a crime 
involving  moral  turpitude  and  their  licenses  were 
revoked.  Because  of  one  of  these  revocations 
the  Board  is  now  involved  in  litigation.  However, 
as  it  now  stands,  the  license  is  revoked.  After 
a careful  investigation,  one  license  which  had  for- 
merly been  revoked  was  restored. 

There  were  forty-four  candidates  who  appeared 
before  the  Board  for  license  by  examination. 
Forty-three  of  these  successfully  passed  the  ex- 
amination and  were  issued  certificates.  Fbrty- 
one  were  graduates  of  the  University  of  Arkansas 
School  of  Medicine,  one  was  a graduate  of  Wo- 
man’s Medical  College  of  Pennsylvania,  one  was 
a graduate  of  the  University  of  Tennessee  Medical 
School  and  one  was  a graduate  of  University  of 
Vienna,  Austria,  Faculty  of  Medicine. 

Fifteen  applicants  were  issued  license  by  re- 
ciprocity as  follows: 

California  (1),  Iowa  (1),  Kansas  (2),  Louis- 
iana (1),  Missouri  (2),  Mississippi  (1),  Oklahoma 
(1)  and  Tennessee  (6). 

Seventeen  licentiates  were  endorsed  to  other 
states  for  license  by  reciprocity  as  follows: 

California  (1),  Iowa  (1),  Kentucky  (1),  Michi- 
gan (2),  Mississippi  (1),  Missouri  (1),  New  Mex- 
ico (3),  Oklahoma  (2),  Texas  (4)  and  West  Vir- 
ginia (1). 

Twenty  applicants  appeared  before  the  Board 
and  successfully  passed  the  examination  given 
on  the  primary  subjects. 

In  conclusion  I wish  to  express  to  this  society 
our  sincere  appreciation  of  the  honor  it  has  be- 
stowed upon  us  and  for  the  privilege  we  have  had 
during  the  past  to  serve  the  profession  and  the 
people  of  this  state.  Our  tasks  at  times  are 
hard  and  we  have  received  practically  no  finan- 
cial remuneration.  However,  I believe  I express 
the  sentiment  of  each  and  every  member  of  the 
Board  when  I state  that  we  really  receive  a great 
enjoyment  which  we  consider  our  reward  for 
doing  our  bit  in  serving  as  members  of  the  State 
Medical  Board. 

A.  S.  BUCHANAN,  Secretary. 


REPORT  OF  DELEGATES  TO  THE  A.  M.  A. 

Dr.  D.  A.  Rhinehart:  Dr.  Bathurst  and  I were 
delegated  from  the  Arkansas  Medical  Society  to 
the  meeting  of  the  American  Medical  Associa- 
tion, held  in  Milwaukee  last  June.  Dr.  Bathurst 
wrote  the  report  of  this  meeting  and  it  was  pub- 
lished in  the  July  number  of  the  Arkansas  Medi- 


cal Journal.  It  has  been  customary  in  times  past 
for  this  report  to  be  accepted  and  adopted  with- 
out further  comment.  I move  the  adoption  of 
this  report  as  published  in  the  Journal. 

The  report  was  adopted. 


REPORT  OF  THE  TREASURER 

Balance  reported  at  1933  session $ 3,152.81 

Receipts — 1933-1934 : 

Secretary’s  account  $5,215.53 

Journal  account  ...  3,527.22 

Student  Loan  Fund  Principal  120.00 

Student  Loan  Fund  Interest 13.65 

Total  Receipts 

10%  dividend  closed  bank 

Total  funds  available  during  year 
Disbursements — - 

Vouchers  422  to  506  inclusive.... 

Cash  on  hand  April  14,  1934 

R.  J.  CALCOTE,  M.D. 


REPORT  OF  THE  SECRETARY 


Balance  on  hand  Sept.  16,  1933 $ 1,459.38 

Receipts — Membership  dues  2,946.00 

Advertising  1 2,200.12 

Student  Loan  Fund  .1 113.65 

Refund  on  secretary’s  bond 4.33 

Dividend  Co-operative  Medical 

Advertising  Bureau  93.45 

10%  dividend  closed  bank 362.22 

Total  to  be  accounted  for 7,179.15 

Disbursements — Paid  Treasurer 4,864.81 

Balance  on  hand  March  31,  1934  2,314.34 


The  society  has  on  deposit  in  the  Gorgas  Fund 
$103.86,  and  in  addition  restricted  deposits  of 
$121.51,  $203.07,  and  $129.09. 

Membership  for  the  year  1933  was  886;  to 
date  the  membership  is  901.  During  the  year  the 
5th  and  6th  Councilor  districts  have  organized 
active  societies,  giving  a 100  iper  cent  organiza- 
tion of  Councilor  districts. 

W.  R.  BROOKSHER. 


REPORT  OF  AUDITING  COMMITTEE 

We,  the  undersigned  committee  of  the  Council, 
have  inspected  the  books  of  the  Secretary  and 
Treasurer,  which  were  audited  September  16th, 
1933,  and  find  them  correct  and  in  excellent  con- 
dition. 

In  checking  the  accounts,  we  find  that  certain 
professional  men  are  in  arrears  for  several  years 
in  payment  for  cards  in  the  Journal,  and  we  sug- 
gest that  this  body  authorize  the  secretary  to  use 
drastic  measures,  if  necessary,  to  collect  this  in- 
debtedness. Signed, 

A.  C.  KOLB, 

L.  L.  PURIFOY, 

S.  J.  WOLFERMANN, 
Chairman. 


$ 8,676.40 
...  718.85 

12,548.06 

7,187.96 

5,360.10 


18 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  1 


ARRANGEMENTS 
Geo.  F.  Jackson,  Chairman 

Dr.  Jackson:  Mr.  President,  and  delegates  of 
the  Arkansas  Medical  Society:  First,  I want  to 

bring  you  greetings  from  the  Pulaski  Medical  So- 
ciety and  to  say  we  certainly  want  you  to  enjoy 
yourselves  while  in  the  City  of  Roses.  We  have 
tried  to  make  all  the  necessary  arrangements  for 
your  entertainment  and  for  your  wives’  entertain- 
ment. The  Auxiliary  has  put  on  a special  enter- 
tainment for  the  ladies,  so  it  will  give  you  boys 
plenty  of  time  to  attend  to  refreshments,  shows, 
and  the  things  you  like,  and  leave  the  ladies  with 
the  Auxiliary.  The  convention  chairmanship  is 
a big  job,  but  it  isn’t  near  as  big  a job  as  the 
committee’s  job.  The  Pulaski  County  Medical  So- 
ciety Committee  on  Entertainment,  Dr.  Brook- 
sher  and  Dr.  Calcote,  has  done  wonderful  work. 
We  have  been  working  on  this  convention  since 
last  October,  and  we  think  the  59th  annual  con- 
vention is  going  to  be  the  biggest  you  have  ever 
attended.  The  commercial  exhibit  is  the  largest 
we  have  ever  had  in  the  society,  having  sixteen 
booths  in  all.  All  the  guest  speakers  have  been 
arranged  for  and  I think  they  will  be  taken  care 
of  by  the  Entertainment  Committee. 

I want  to  call  particular  attention  to  the  Fish- 
bein  lecture  at  the  Senior  High  School  audito- 
rium tonight.  The  subject  is  “Fads  and  Quackery 
in  Medicine.”  You  all  know  that  Dr.  Fishbein  is 
one  of  the  American  Medical  Association’s  best 
orators,  and  we  certainly  want  you  to  take  the 
ladies  and  be  on  hand.  There  will  be  cars  to 
transport  you  from  the  hotel  to  the  high  school 
auditorium.  The  governor  is  also  to  speak  on  this 
program.  So  I would  like  to  see  all  of  the  repre- 
sentatives of  the  society  at  that  'meeting.  We 
expect  a crowd  of  something  like  2,000  people. 

The  publicity  of  this  convention  has  been 
handled  by  Dr.  Jerome  Levy  and  Dr.  D.  A.  Rhine- 
hart  of  Little  Rock.  About  six  or  seven  thousand 
letters  have  been  sent  out  of  the  different  offices. 
Four  thousand  have  been  sent  out  by  my  office 
on  this  convention.  Several  notices  were  printed 
in  the  newspapers. 

There  is  to  be  a golf  tournament  for  those  of 
you  who  want  to  play  golf  at  the  country  club. 

Tomorrow  night  at  6:30  in  this  room  there  will 
be  a banquet.  The  committee  is  composed  of  one 
man,  Dr.  M.  J.  Kilbury,  and  he  is  some  man  when 
it  comes  to  putting  on  a banquet.  He  will  have 
a floor  show  that  will  be  worth  while.  The  Pres- 
ident’s reception  and  ball  follows  that  in  this 
same  room.  We  want  to  see  you  all  present. 

For  your  information,  the  refreshment  room  is 
Room  212.  We  want  you  to  forget  all  your 
troubles  and  have  a good  time.  We  don’t  want 
you  to  have  anything  else  but  a good  time  and, 
if  there  is  anything  you  want,  anything  we  can 
do  for  you,  just  let  us  know. 

The  President:  These  reports  will  be  referred 
to  the  Reference  Committee  and  brought  back  to 
the  House  of  Delegates  for  their  action. 

The  selection  of  the  Nominating  Committee  be- 
ing in  order,  the  following  were  chosen: 

First  Councilor  District — F.  H.  Jones,  Piggott. 


Second  Councilor  District — L.  T.  Evans,  Bates- 
ville. 

Third  Councilor  District — 0.  L.  Williamson, 
Marianna. 

Fourth  Councilor  District — J.  M.  Lemons,  Pine 
Bluff. 

Fifth  Councilor  District — L.  L.  Purifoy,  El  Do- 
rado. 

Sixth  Councilor  District — T.  F.  Kittrell,  Tex- 
arkana. 

Seventh  Councilor  District — G.  B.  Fletcher,  Hot 
Springs. 

Eighth  Councilor  District — Fay  H.  Jones,  Lit- 
tle Rock. 

Ninth  Councilor  District — J.  G.  Gladden,  West- 
ern Grove. 

Tenth  Councilor  District — H.  Moulton,  Fort 
Smith. 

The  President:  That  completes  the  re- 
ports of  all  the  committees.  I want  to  in- 
troduce to  the  House  of  Delegates  the  past- 
presidents,  and  will  ask  them  to  come  for- 
ward at  this  time.  Drs.  Lemons,  Barlow, 
Moulton  and  Rhinehart  were  introduced. 
This  shows  that  these  gentlemen  who  have 
been  so  honored  by  the  Society  have  not 
forgotten  their  duty,  love  and  affection  for 
the  Arkansas  Medical  Society.  I thank 
them  for  being  present. 

A telegram  was  read  from  Dr.  E.  F.  El- 
lis, of  Fayetteville.  By  motion,  the  Society 
wired  regrets  to  Dr.  Ellis. 

On  motion  the  House  of  Delegates  ad- 
journed. 

HOUSE  OF  DELEGATES 

Wednesday,  April  18,  1934. 

The  House  of  Delegates  was  called  to 
order  by  the  President,  Dr.  Kosminsky,  at 
1 :30  p.  m.,  there  being  present  63  mem- 
bers, either  regular  delegates  or  alter- 
nates, or  members  duly  seated  as  such  by 
the  House. 

The  Nominating  Committee  reported : 

For  President-Elect:  H.  T.  Smith,  McGehee;  M. 
E.  McCaskill,  Little  Rock;  Earle  H.  Hunt,  Clarks- 
ville. 

For  1st  Vice-President:  A.  M.  Elton,  Newport. 

For  2d  Vice-President:  S.  C.  Fulmer,  Little 
Rock. 

For  3d  Vice-President:  F.  D.  Smith,  Blythe- 
ville. 

For  Secretary:  W.  R.  Brooksher,  Fort  Smith. 

For  Treasurer:  R.  J.  Calcote,  Little  Rock. 

COUNCILORS 

Second  District:  Sam  J.  Allbright,  Searcy. 


June,  1934] 


ARKANSAS  MEDICAL  SOCIETY 


19 


Fourth  District:  C.  W.  Dixon,  Gould. 

Sixth  District:  Don  Smith,  Hope. 

Eighth  District:  S.  B.  Hinkle,  Little  Rock. 

Tenth  District:  S.  J.  Wolfermann,  Fort  Smith. 

Delegate  to  the  A.  M.  A.,  two  years:  L.  J.  Kos- 
minsky,  Texarkana. 

Delegate  to  the  A.  M.  A.,  one  year:  W.  R. 
Brooksher,  Fort  Smith. 

By  motion,  the  report  was  adopted. 

H.  King  Wade,  of  Hot  Springs,  J.  G. 
Gladden,  of  Western  Grove,  and  R.  L. 
Smith,  of  Russellville,  were  appointed  as 
tellers,  and  the  House  of  Delegates  pro- 
ceeded to  ballot  upon  the  three  names  se- 
lected by  the  Nominating  Committee,  H. 
T.  Smith,  M.  E.  McCaskill  and  Earle  H. 
Hunt,  for  the  office  of  President-Elect. 
Upon  the  third  ballot,  H.  T.  Smith  retiring 
after  the  second  ballot,  M.  E.  McCaskill 
received  a majority  of  all  the  votes  cast 
and  was  declared  elected.  By  motion  of 
Earle  H.  Hunt,  seconded  by  H.  T.  Smith, 
the  election  was  made  unanimous. 

The  President:  You  have  elected  Dr.  Mc- 
Caskill as  your  President-Elect  for  the  en- 
suing year.  (Applause.) 

By  motion  the  secretary  was  instructed 
to  cast  the  ballot  for  the  rest  of  the  offi- 
cers. 

The  Secretary : It  gives  me  great  pleas- 
ure to  cast  the  unanimous  ballot  of  this 
House  for  all  the  other  officers  nominated 
except  that  of  Secretary. 

The  President:  I will  cast  that  ballot. 
The  only  outstanding  committee  is  the 
Reference  Committee,  whose  report  we 
will  hear  by  Dr.  Jones. 

REPORT  OF  THE  REFERENCE  COMMITTEE 

Mr.  President  and  members  of  the  Arkansas 

Medical  Society: 

We,  the  Reference  Committee,  have  carefully 
considered  all  written  reports  submitted  to  us. 
We  heartily  commend  the  committees  for  their 
work. 

The  President’s  address  was  a most  splendid 
and  inspiring  one,  and  we  heartily  recommend  it 
to  the  Society  for  deep  thought  and  study. 

We  wish  to  especially  commend  R.  B.  Robins, 
chairman  of  the  Scientific  Program,  for  a most 
excellent  and  interesting  program. 

H.  Fay  H.  Jones,  chairman  of  the  Committee 
on  Scientific  Exhibits.  The  report  of  this  com- 
mittee is  exceedingly  satisfactory  and  we  think 
the  co-operation  of  the  exhibitors  has  been  ex- 
cellent and  that  endeavors  in  the  future  should 
be  made  to  increase  the  interest  of  the  society 


in  the  Scientific  Exhibit.  We  commend  the  com- 
mittee for  its  untiring  work-in  securing  the  ex- 
hibits for  the  present  year. 

L.  V.  Parmley,  chairman  of  the  Medical  Leg- 
islation, gave  us  his  usual  concise  report.  This 
report  recommends  legislation  limiting  anesthesia 
to  graduates  of  medicine.  We  would  suggest  that 
now  is  an  inopportune  time  to  ask  for  such  legis- 
lation. 

W.  B.  Grayson,  chairman  of  the  Health  and 
Public  Instruction  Committee,  gave  us  an  excel- 
lent report  and  we  commend  the  course  the  com- 
mittee is  pursuing. 

W.  Decker  Smith,  chairman  of  the  Committee 
on  Cancer  Control.  We  commend  the  report  of 
this  committee  and  its  very  excellent  scientific 
exhibits. 

W.  F.  Smith,  chairman  of  the  Committee  on 
Hospitals.  We  endorse  the  report  of  the  com- 
mittee and  thank  Dr.  Smith  for  his  interesting 
report  as  Fraternal  Delegate  to  the  Texas  State 
Medical  Society. 

Jerome  S.  Levy,  chairman  of  the  Publicity 
Committee. 

S.  A.  Drennen,  chairman  of  the  Child  Welfare 
Committee. 

A.  G.  Sullivan,  chairman  of  the  Committee  on 
Diseases  of  the  Heart.  The  reports  of  these 
committees  are  endorsed  by  the  committee. 

Geo.  F.  Jackson,  chairman  of  the  Committee  on 
Arrangement.  This  committee  is  to  be  thanked 
for  its  excellent  provisions  for  the  entertainment 
of  the  society  this  year. 

M.  E.  McCaskill,  chairman  of  the  Council.  The 
report  of  the  Council  should  be  accepted  and  the 
Council  thanked  for  its  excellent  work  during  the 
year. 

A.  S.  Buchanan,  chairman  of  the  State  Board 
of  Medical  Examiners.  This  report  shouM  be  en- 
dorsed and  the  committee  commended  for  its  ef- 
forts to  eliminate  from  the  state  incompetent  and 
irregular  practitioners. 

H.  FAY  H.  JONES. 

H.  MOULTON. 

EARLE  H.  HUNT. 

By  motion  the  report  was  accepted  and 
the  committee  discharged. 

The  President:  Under  the  head  of  new 
business,  I had  the  opportunity  of  thanking 
the  Council  for  their  hearty  co-operation 
in  the  past  year.  Every  member  was  pres- 
ent at  every  meeting  that  was  called.  I 
want  to  thank  the  committee  in  Little  Rock 
for  the  wonderful  convention  they  have 
given  us,  and  I want  to  thank  the  mem- 
bership of  the  Arkansas  Medical  Society 
for  the  wonderful  co-operation  they  have 
given  me.  It  will  be  a memory  to  be  cher- 
ished until  the  last  call,  and  I only  bespeak 
for  my  successor  the  same  wonderful  co- 


20 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  1 


operation  that  you  have  given  me.  I want 
you  to  know  that  I am  with  organized 
medicine  and  the  Arkansas  Medical  Socie- 
ty until  the  Last  Roll  Call.  Gentlemen,  I 
want  to  entertain  a motion  by  some  one  to 
thank  the  Pulaski  County  Medical  Society, 
the  hotels  and  the  various  people  that 
helped  to  make  this  such  a wonderful 
meeting. 

Dr.  King  Wade:  I make  that  motion. 

Carried. 

The  President:  We  will  now  have  the 
final  report  of  the  Council  by  Dr.  McCas- 
kill,  your  President-Elect. 

REPORT  OF  MEETINGS  OF  THE  COUNCIL 
APRIL  16,  17,  18,  1934 
April  16th,  1934: 

Auditing  committee  appointed.  Resolution  urg- 
ing members  to  patronize  Journal  advertisers 
adopted.  Ordered  new  constitution  printed. 

April  17th,  1934: 

Recommended  that  three  dollars  be  accepted  as 
dues  for  1935.  Declined  to  seat  delegate  from 
Phillips  County  because  of  failure  of  society  to 
submit  report  and  dues.  Authorized  appointment 
of  publication  committee.  Authorized  payment 
of  expenses  of  annual  session  and  a contribution 
of  one  hundred  dollars  to  Pulaski  County  Medical 
Society  toward  expense  of  annual  session.  Heard 
A.  S.  Buchanan,  secretary,  State  Board  of  Med- 
ical Examiners,  and  appointed  committee  to  con- 
fer with  and  assist  this  board  financially  if  neces- 
sary in  certain  court  proceedings  relative  to  re- 
vocations of  licensure.  Allowed  usual  honorari- 
ums to  Secretary-Editor  and  Attorney.  Adopt- 
ed report  of  auditing  committee  (page  17). 

April  18th,  1934: 

Sent  message  of  sympathy  to  Morgan  Smith, 
absent  because  of  illness.  Allowed  delegates  to 
American  Medical  Association  fifty  dollars  on  ex- 
penses. Authorized  chairman  to  appoint  a mem- 
ber representing  the  state  society  on  commercial 
exhibits  committee  of  host  society,  revenue  de- 
rived therefrom  to  be  allowed  the  host  society  on 
expenses,  any  excess  to  revert  to  the  state  socie- 
ty. Ordered  the  secretary 'to  make  such  adjust- 
ments on  arrears  for  professional  advertising  as 
is  deemed  proper.  Authorized  secretary  to  make 
such  disbursements  on  account  of  the  legislative 
committee  as  are  necessary,  such  to  be  decided  by 
conferences  between  the  committee,  the  attorney 
and  the  secretary.  Madison  County  Medical  So- 
ciety was  continued  in  active  membership. 

M.  E.  McCASKILL,  Chairman. 

S.  J.  WOLFERMANN,  Secretary. 

On  motion,  the  report  was  adopted. 

The  House  of  Delegates  then  adjourned. 

<$> 

GENERAL  SESSION 

The  General  Session  was  called  to  order 
at  1 :30  o’clock,  P.  M.,  April  16,  1934,  by 
Dr.  Kosminsky,  President. 

Invocation  by  Rev.  L.  A.  Taylor. 


ADDRESS  OF  WELCOME 

On  Behalf  of  Pulaski  County  Medical 
Society,  A.  C.  Shipp,  Little  Rock. 

Mr.  President,  Members  of  the  Arkan- 
sas Medical  Society  and  Auxiliary:  I have 
been  given  the  key  to  the  city  of  Little 
Rock  to  deliver  to  you.  I assure  you  in 
behalf  of  the  citizens  of  Little  Rock,  of 
which  I am  one,  that  you  are  welcome.  Cer- 
tainly a welcome  from  the  city  of  Little 
Rock  is  an  unselfish  one.  But  as  the  rep- 
resentative of  the  Pulaski  County  Medical 
Society  I want  to  assure  you  of  a heartfelt 
welcome.  I want  to  tell  you  that  we  have 
had  a little  feeling  this  year,  in  the  face 
of  social  service  and  alphabetical  dicta- 
tions, that  we  were  rather  a very  unim- 
portant group  of  fellows  and  that  we  were 
rapidly  developing  an  inferiority  complex. 
There  was  a time  when  we  felt  that  to  be 
a physician  was  to  be  an  outstanding  ser- 
vant of  the  public,  to  be  recognized  as  such, 
but  we  began  to  doubt  that  and  we  felt 
like  the  boy  about  12  or  14  years  old  that 
went  over  on  the  other  side  of  town  and 
the  other  gang  got  hold  of  him.  He  felt 
very  insignificant.  But  today  we  feel  like 
our  gang  is  here  and  we  are  feeling  bet- 
ter. We  are  feeling  very  much  encour- 
aged at  the  support  of  this  group.  So,  I 
say  you  are  thrice  welcome  in  the  encour- 
agement and  support  that  we  get  by  being 
together.  You  are  welcome  because  we 
know  that  you  come  here  to  Little  Rock 
with  a solution  of  our  problems  in  your 
hands,  and  you  are  going  to  hand  them  out, 
and  they  are  all  going  to  be  settled  while 
you  are  here.  We  know  this  because  of 
your  fitness  to  solve  these  problems  and 
our  fitness  to  solve  them.  We  will  admit 
it  whether  anybody  else  does  or  not.  We 
admit  that  we  have,  by  training,  by  ex- 
perience, by  magnanimity  of  spirit  and  so- 
cial out-look,  all  that  qualifies  a group  of 
individuals  to  deal  with  these  complex  so- 
cial problems  that  are  coming  on  in  this 
day  of  a New  Deal.  So,  I say  that  our  wel- 
come to  you,  since  you  are  going  to  bring 
an  answer  to  these  things,  is  one  of  triple 
welcome,  and  we  will  be  glad  to  join  with 
you  in  discussing  the  many  things  that  we 
must  deal  with  now  in  this  day  of  new 
deals.  These  new  deals  and  new  prob- 
lems will  demand  new  measures  and  new 
means;  but  with  your  preparation  and 


June,  1934] 


ARKANSAS  MEDICAL  SOCIETY 


21 


your  experience  in  dealing  with  these,  with 
the  fairness  that  is  inherent  in  your  every 
training  and  in  the  very  things  that  make 
you  want  to  become  a physician,  we  feel 
sure  that,  if  the  profession,  but  above  the 
profession  and  beyond  all  else  the  personal 
unselfishness  of  society  at  large,  will  help 
this  group  that  is  coming  to  Little  Rock 
to  join  hands  with  those  of  other  states 
over  this  great  nation  of  ours  and  through 
our  great  national  association  offer  a con- 
tribution to  society,  our  successors  in  the 
American  Medical  Association  and  the  Ar- 
kansas Medical  Society  will  be  proud  to 
recognize  as  a contribution  of  unselfish 
men  and  women  to  society’s  problems. 
Again,  I bid  you,  in  the  name  of  the  Pu- 
laski County  Medical  Society,  a welcome. 
(Applause.) 


ADDRESS  OF  WELCOME 

Mayor  Horace  A.  Knowlton,  Little  Rock 

I regret  that  I was  unavoidably  de- 
tained at  the  high  school  on  another  en- 
gagement which  prevented  my  arriving  at 
this  session  in  time  to  hear  the  very 
eloquent  response  that  was  made  to  the 
address  of  welcome  that  had  already 
been  given.  You  know  it  is  a pleas- 
ure to  me,  as  mayor  of  the  city,  to  wel- 
come a group  like  this.  You  know  usual- 
ly somebody  else  pays  for  the  doctor’s 
visit.  This  time  the  doctors  are  visiting, 
and  they  are  doing  the  paying,  too.  When 
I come  before  a group  of  doctors,  I come 
with  a feeling  of  the  very  greatest  respect. 
I have  the  very  highest  regard  and  esteem 
for  your  profession.  I think  I evidence 
that  in  the  fact  that  I have  just  one  son 
and  early  in  his  youth  I began  talking  to 
him  about  the  profession  that  I wanted 
him  to  follow.  I believe  that  every  boy 
should  follow  those  things  that  he  has  a 
natural  bent  for.  I was  anxious  for  him 
to  do  the  things  that  I thought  would 
bring  the  greatest  good  to  humanity,  and 
I talked  to  him  of  the  very  great  profes- 
sion of  medicine.  Later  on  when  he  en- 
tered college  it  was  with  the  intention  of 
later  entering  a medical  school,  and  he  is 
now  serving  his  second  year  interneship 
in  the  Barnes  hospital  in  St.  Louis,  in 
which  I take  great  pride.  If  the  average 
layman  knew  as  much  about  the  expense 


that  attaches  to  the  making  of  a physician 
as  I do,  he  wouldn’t  grumble  at  the  fees 
that  he  has  to  pay.  (Applause.) 

But  I do  take  great  pleasure  in  welcom- 
ing to  this  city  a group  which  has  taken 
for  its  creed  Humanity. 

It  is  a distinct  pleasure  to  me  to  bid  you 
welcome.  If  while  you  are  here  we  can 
serve  you,  it  is  going  to  be  a pleasure  to 
us.  All  you  have  to  do  is  to  just  let  us 
know  what  you  want  and  we  will  try  to 
meet  your  wishes.  It  is  very  gratifying  to 
me  to  state  to  you  that  our  medical  school 
in  this  city  is  expecting  this  next  year  to 
have  a $500,000  building  erected  out  here 
just  south  of  the  city  hospital.  The  city 
hospital  is  taking  care  of  our  poor  pa- 
tients; they  have  done  a most  noble  work 
among  the  poor  people  of  this  city.  Just 
now,  it  is  our  misfortune  that  with  our  de- 
creasing revenues  we  have  an  increasing 
number  of  patients  at  the  city  hospital  but 
at  the  same  time  those  patients  are  being 
taken  care  of,  and  there  has  been  no  let 
up  in  the  services  rendered. 

I want  to  again  repeat  to  you  that  it  is 
a distinct  privilege  and  a distinct  honor 
in  being  able  to  bid  you  welcome  to  our 
city  and  we  hope  that  your  impressions 
will  only  be  such  as  to  cause  you  to  want 
to  visit  us  often.  I thank  you.  (Applause.) 

The  President:  Mr.  Mayor,  on  behalf  of 
the  Arkansas  Medical  Society,  I want  to 
thank  you  for  your  address  of  welcome, 
and  I know  that  the  medical  men  of  Ar- 
kansas as  well  are  always  glad  to  hear  of 
some  official  who  has  let  some  one  of  his 
family  enter  medicine. 


RESPONSE 

On  Behalf  of  the  Arkansas  Medical  Socie- 
ty, Will  H.  Mock,  Prairie  Grove. 

Mr.  President,  Members  of  the  Arkan- 
sas Medical  Society,  the  Pulaski  County 
Medical  Society  and  the  city  of  Little 
Rock : If  I possessed  the  talents  of  the  ora- 
tor’s art  with  a knowledge  of  word  paint- 
ing with  its  tints,  shades  and  colors,  I 
would  really  be  unable  to  express  our  ap- 
preciation for  the  hospitality  and  all  the 
courtesies  that  have  been  extended  us.  In 
fact,  we  have  been  offered  everything  from 
the  Capitol  to  police  headquarters.  We 


22 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  1 


feel  just  as  welcome  as  the  roses  in  June, 
as  welcome  as  the  dew-drop  is  to  the  petals 
of  the  infant  plant,  just  as  welcome  as  is 
the  sea  captain’s  return  to  his  family  fire- 
side when  for  days  and  weeks  he  has  been 
piloting-  his  great  ship  across  the  briny 
deep,  out  where  the  billows  roll  high.  He 
has  faced  the  fury  of  the  storm,  the  light- 
ning’s vivid  flash  and  the  thunder’s  sul- 
len roar,  but  through  it  all  his  great  ship 
struggled  like  a thing  of  life  and  the  tim- 
bers groaned  in  the  awful  strife  as  it  plow- 
ed its  way  through  the  dashing  foam  into 
the  harbor  of  home. 

We  have  brought  to  the  City  of  Roses 
a group  of  men  who  represent  the  highest 
type  of  citizenship.  Its  requisites  are  an 
open  mind,  a generous  heart,  a willing- 
ness to  see  the  good  in  others,  and  a reluct- 
ance to  criticise  or  doubt  their  motives,  a 
good  neighbor,  one  who  seeks  to  add  some- 
thing to  the  happiness,  physical,  moral  and 
social  welfare  of  his  city  and  country;  al- 
ways displaying  a spirit  of  tolerance  and 
generosity,  a disposition  to  recognize  true 
worth  and  merit  in  others,  always  apply- 
ing the  principles  of  equality  and  justice 
in  all  their  business  and  social  relation- 
ships, and  whose  influence  will  be  reflect- 
ed and  will  carry  on  down  through  the 
corridors  of  Time.  This  society  is  com- 
posed of  a group  of  men  whose  interest  in 
and  love  for  humanity  is  the  greatest, 
whose  mission  in  life  is  the  alleviation  of 
pain  and  human  suffering.  The  Arkansas 
Medical  Society  holds  at  the  command  of 
our  citizenship  an  ever  faithful,  watchful 
and  willing  service,  which  will  continue  to 
improve  and  will  grow  and  spread  and  ex- 
tend, like  a golden  mantle  of  truth,  benevo- 
lence and  love  until  life  and  its  lights  have 
passed. 

Dr.  Gann:  We  will  now  hear  the  Presi- 
dent’s address. 

(The  President’s  address  is  printed  on  page  1.) 


On  motion,  following  the  scientific  pro- 
gram, the  General  Session  adjourned. 

GENERAL  SESSION 

Wednesday,  April  18,  1934. 

The  General  Session  was  called  to  order 
by  the  President  immediately  after  the 
adjournment  of  the  House  of  Delegates. 


The  President:  Is  there  any  unfinished 
business?  I would  like  to  ask  Dr.  Moulton 
and  Dr.  Lemons  to  escort  the  new  presi- 
dent, Dr.  Mahony,  to  the  rostrum.  (Dr. 
Mahony  was  escorted  to  the  rostrum  amid 
applause.)  Gentlemen,  I want  to  present 
to  you  your  president  for  the  year  1934- 
35,  Dr.  F.  0.  Mahony  of  El  Dorado.  (Ap- 
plause.) Dr.  Mahony,  I want  to  present 
to  you  the  gavel,  the  emblem  of  authority, 
and  may  your  administration  be  crowned 
with  the  same  hearty  co-operation  as  mine, 
and  when  you  have  completed  your  year  of 
service  may  the  Arkansas  Medical  Society 
and  its  members  be  as  dear  and  as  near  to 
you  as  they  have  been  to  the  retiring  pres- 
ident. (Applause.) 

Dr.  Mahony:  Dr.  Kosminsky,  Fellow  Members 
of  the  Arkansas  Medical  Society,  and  Visitors: 
I recognize  fully  and  deeply  appreciate  the  great 
honor  that  has  been  bestowed  upon  me.  It  is 
accepted  by  me  and  duly  recognized  as  the  high- 
est tribute  available  to  a physician  in  this  state. 
I accept  the  honor  and  pledge  in  return  my  very 
best  efforts.  I am  constantly  reminded  of  the 
many  outstanding  and  conspicuous  contributions 
made  by  my  several  .predecessors,  particularly 
that  charming  and  distinguished  gentleman  and 
physician,  Dr.  Kosminsky.  It  will  be  difficult 
for  me  to  proceed  where  this  gentleman  has  left 
off  and,  though  I accept  the  challenge  with  no 
little  trepidation,  I posses  an  honest  determina- 
tion to  do  my  best,  having  as  I do  the  sympa- 
thetic support  of  all  members  of  organized  medi- 
cine in  this  great  commonwealth. 

Gentlemen,  the  days  before  us  are  difficult. 
We,  as  a people,  are  facing  an  era  filled  with 
serious  economic  and  social  problems.  As  a pro- 
fession, if  we  are  to  safeguard  the  very  high 
principles  for  which  we  stand,  we  must  enter 
seriously  and  intelligently  into  this  period  of  re- 
adjustment. As  a nation,  our  entire  economic 
structure  is  undergoing  gradual  though  perma- 
nent readjustment.  Now  is  an  occasion  for  in- 
telligent, bi'oad-minded  leadership.  We  can  ill 
afford  to  evade  the  issue.  In  the  year  ahead  of 
me,  gentlemen,  I respectfully  solicit  your  con- 
siderate support  and  active  co-operation.  (Ap- 
plause.) 

I am  going  to  ask  Dr.  Smith  and  Dr. 
Hunt  to  escort  Dr.  McCaskill  to  the  sta- 
tion. (Dr.  McCaskill  was  escorted  to  the 
rostrum  amid  applause.)  Gentlemen, 
President-Elect  McCaskill,  of  Little  Rock. 
(Applause.) 

Dr.  McCaskill : Gentlemen,  I thank  you. 
I hope  to  administer  this  office  next  year 
by  giving  you  the  best  that  I have.  I am 
not  going  to  attempt  to  make  a speech  be- 
cause there  are  better  speech  makers.  I 
can’t  make  you  a good  president  if  it  re- 


June,  1934] 


ARKANSAS  MEDICAL  SOCIETY 


23 


quires  very  much  speech  making,  but  I 
promise  you  that  I will  give  you  the  best 
that  I have.  (Applause.) 

Dr.  F.  D.  Smith,  of  Blytheville,  the  First 
Vice-President,  was  introduced  amidst  ap- 
plause. 

President  Mahony:  Gentlemen,  the  of- 
fice of  President  is  quite  an  honor  but  it 
also  requires  a lot  of  time.  This  year  I 
am  going  to  ask  our  vice-presidents  and 
our  various  committee  chairmen  to  divide 
with  me  some  of  the  labors  to  help  in  car- 
rying on  the  meetings  and  the  business  of 
the  Arkansas  Medical  Society  to  the  end 
that  we  may  gain  more  membership,  more 
harmony  and  a better  grade  of  physicians. 
When  it  is  impossible  or  inconvenient  for 
me  to  visit  some  places  in  the  state,  I am 
going  to  feel  at  liberty  to  call  upon  these 
gentlemen  to  help  me.  It  will  give  them 
more  acquaintance,  and  it  is  my  idea  that 
the  more  work  a fellow  has  to  do  in  any- 
thing the  better  he  likes  it  and  the  more 
interest  he  will  take,  and,  interest  is  what 
we  will  need.  Is  there  any  new  business 
to  come  before  this  meeting?  If  not,  then 
the  next  order  of  business  will  be  the  se- 
lection of  your  meeting  place  for  next  year. 

Dr.  Purifoy:  Members  of  the  Arkansas 
Medical  Society,  it  affords  me  a great  deal 
of  pleasure  to  invite  you  to  meet  at  El  Do- 
rado next  year,  the  best  town  in  Arkan- 
sas. You  are  welcome  and  we  will  be  glad 
to  have  you  meet  there.  (Applause.) 

Dr.  Jones:  As  president  of  the  Sebas- 
tian County  Medical  Society  I wish  to  in- 
vite you  to  Fort  Smith  next  year.  I have 
in  my  hand  a number  of  telegrams  invit- 
ing you,  from  the  Mayor  of  the  city,  the 
Chamber  of  Commerce,  the  Lions  Club,  the 
Kiwanis  Club,  the  Exchange  Club,  the 
Rotary  Club  and  the  Noon  Civic  Club.  I 
will  not  burden  you  by  reading  all  these 
invitations.  We  want  you.  We  will  try 
to  put  on  a good  program  for  you  and  en- 
tertain you  as  well  as  we  can.  I hope  that 
you  will  consider  our  invitation  with  Dr. 
Purifoy’s.  I thank  you.  (Applause.) 

Dr.  Buchanan:  I wouldn’t  have  extend- 
ed this  invitation  to  you  to  come  to  Pres- 
cott next  year  if  it  hadn’t  been  that  Dr. 
Purifoy  said  that  El  Dorado  was  the  best 
town  in  Arkansas.  He  is  absolutely  wrong. 
Prescott  is  a town  of  about  3,000  people. 


We  have  four  hotels  and  the  smallest  ho- 
tel there  can  take  care  of  the  Arkansas 
Medical  Society.  We  have  there  the  most 
wonderful  fishing  lake  in  the  United 
States,  only  six  miles  from  town.  And  we 
most  cordially  and  respectfully  invite  you 
to  Prescott  for  your  next  meeting.  (Ap- 
plause.) 

Dr.  Parker:  There  is  a little  town  in 
the  northwestern  section  of  the  state  that 
wants  you  to  have  your  meeting  there,  Eu- 
reka Springs.  The  things  said  about  Pres- 
cott are  true  of  Eureka  Springs.  We  have 
hotels  that  we  can  put  two  of  theirs  in  one 
of  ours.  We  want  you  to  consider  Eureka 
Springs  with  the  rest  of  them.  Dr.  Brook- 
sher  has  a bunch  of  telegrams. 

Secretary  Brooksher:  I have  telegrams 
from  the  president  of  the  Rotary  Club,  the 
Men’s  Club,  the  Basin  Park  Hotel  and  the 
Chamber  of  Commerce,  the  local  Ameri- 
can Legion  and  the  Mayor,  in  which  they 
reinforce  what  Dr.  Parker  has  said.  I 
also  have  a telegram  from  the  Chamber  of 
Commerce  at  Hot  Springs. 

Dr.  Buchanan:  I object  to  all  these  tele- 
grams. I could  have  gotten  a telegram 
from  every  man  in  Prescott.  (Laughter.) 

Dr.  Fletcher:  Hot  Springs  is  quite  will- 
ing to  withdraw  and  not  offer  an  invita- 
tion for  the  meeting. 

Dr.  Purifoy : Let’s  hear  from  Dr.  Smith 
from  Smackover. 

Dr.  Smith:  I am  from  Union  County. 
Several  of  our  leading  members  are  more 
than  glad  to  invite  you  and  give  you  a 
hearty  welcome  to  El  Dorado  next  year. 

Fort  Smith  was  duly  selected  as  the 
meeting  place  for  1935,  the  final  voting 
being  conducted  between  El  Dorado  and 
Fort  Smith. 

There  being  no  further  business,  the 
General  Session  adjourned  sine  die. 


MEMORIAL  SESSION 
Marion  Hotel 

Tuesday,  April  17,  1934.  8:30  o’clock 

A.  M. 

The  Memorial  Session  was  called  to  or- 
der by  the  President. 


24 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  1 


The  invocation  was  given  by  Rev.  C.  M. 
Reves,  pastor  of  the  First  Methodist 
Church. 

Song:  “When  They  Ring  the  Golden 
Bells  for  You  and  Me.” — Mrs.  I.  J.  Steed, 
Soprano;  Mrs.  W.  R.  Richardson,  Contral- 
to; Max  Brown,  Tenor;  Byron  Bennett, 
Bass.  Mrs.  S.  R.  Crawford,  Accompa- 
nist. 

The  President : Ladies  and  Gentlemen : 
This  is  the  hour  set  aside  each  year  in 
memory  of  those  who  have  taken  that  long 
journey  from  whence  no  traveler  returns. 
We  believe  in  that  motto,  “The  faults  of 
our  brothers  we  write  upon  the  sands,  their 
virtues  upon  the  tablets  of  love  and  mem- 
ory.” Our  memorial  address  will  be  de- 
livered by  the  dean  of  the  medical  depart- 
ment of  the  University  of  Arkansas,  Dr. 
Frank  Vinsonhaler. 

Dr.  Vinsonhaler:  Mr.  President,  Ladies 
and  Gentlemen:  For  some  years  it  has 

devolved  upon  me,  as  chairman  of  the 
Committee  on  Necrology,  to  deliver  at  this 
time  a memorial  address  in  memory  of 
those  who  have  passed  away.  Last  year 
at  Hot  Springs  I had  this  duty  to  perform. 
Some  of  those  who  were  present  on  that 
occasion  are  no  longer  here.  Voices  that 
spoke  to  me  in  commendation  of  what  I 
had  said  upon  that  occasion  are  now  silent 
forever. 

We  are  reminded  at  a time  like  this  of 
the  spirit  of  change.  This  spirit  of  change 
is  evident  everywhere.  Now,  at  spring- 
time, with  all  the  promise  of  a glorious 
new  year.  We  passed  through  the  autumn 
of  old  age,  through  the  winter  of  Death, 
and  now  Nature  smiles  Upon  us  again  and 
welcomes  us  to  a year  of  new  achieve- 
ments. 

Forty-one  years  ago  I attended  the  first 
meeting  of  the  Arkansas  Medical  Society 
at  Batesville.  In  the  audience  here  before 
me  today  I see  not  one  face  that  I saw 
upon  that  occasion.  All  have  passed  away. 

Since  that  time  the  Ladies  Auxiliary  has 
been  born.  From  the  midst  of  these  wo- 
men, who  have  contributed  so  much  to  the 
interest  of  this  society,  death  takes  its  toll 
this  year  as  it  has  in  the  past.  These 
names  have  been  handed  to  me  by  the  pres- 
ident of  the  Ladies  Auxiliary: 

Mrs.  F.  C.  Robinson,  Little  Rock. 


Mrs.  Roberta  Smith,  Fort  Smith. 

Mrs.  D.  B.  Stough,  Hot  Springs. 

Each  succeeding  year  has  made  evident 
to  us  their  interest  and  affection  in  and 
for  this  society.  We  pay  to  them  the  tri- 
bute of  respect  and  affection. 

I will  read  to  you  the  names  of  those 
of  our  members  who  have  passed  away 
during  the  past  year. 


Percy  Alexander  Riddler,  Fort  Smith, 
April  30,  1933. 

William  Brand,  Springdale,  May  15, 
1933. 

Luther  Edgar  Moore,  Searcy,  June  4. 
1933. 

Lem  H.  Lipsey,  Wynne,  July  12,  1933. 

Thomas  N.  Rodman,  Batesville,  July  20, 
1933. 

Eugene  H.  Winkler,  DeWitt,  August  19, 
1933. 

William  Ray  Bathurst,  Little  Rock, 
August  31,  1933. 

Harry  Norwood  Street,  Lonoke,  Octo- 
ber 3,  1933. 

Samuel  Robert  Herring,  Warren,  Octo- 
ber 28,  1933. 

Harry  Wynne  Browning,  Little  Rock, 
November  3,  1933. 

J.  M.  McLendon,  Gould,  November  20, 
1933. 

Grover  Cleveland  Webb,  Russellville, 
November  27,  1933. 

Walter  Oling  Parrish,  Rector,  Decem- 
ber 29,  1933. 

Franklin  Beverly  Kirby,  Harrison,  Jan- 
uary 20,  1934. 

Albert  Henry  Gilbrech,  Clarendon,  Feb- 
ruary 27,  1934. 

William  S.  Norman,  Hamburg,  March 
13,  1934. 

William  Edward  Hughes,  Pocahontas, 
March  27,  1934. 


No  doubt  there  are  present  those  in  this 
audience  to  whom  the  memory  of  these 
men  speaks  with  peculiar  force  and  affec- 
tion. It  is  impossible,  of  course,  to  speak 
of  them  all.  I remember  Browning  when 
he  was  a medical  student  in  the  school  of 
which  I was  a teacher.  He  was  a young 
man  of  unusual  promise,  and  was  taken 
early  in  life.  There  was  so  much  before 
him;  so  much  to  accomplish.  Some  one 


ARKANSAS  MEDICAL  SOCIETY 


25 


June,  1934] 


said  that  perhaps  that  is  the  best  time  to 
go,  with  every  sail  set,  with  the  music  of 
the  breeze  in  the  rigging,  not  a cloud  in 
the  sky,  “to  strike  the  unseen  rock,  and 
hear  the  breakers  roar  above  a sunken 
ship.” 

Franklin  Beverly  Kirby,  of  Harrison, 
the  distinguished  son  of  a distinguished 
father,  known  to  most  of  us,  known  to 
nearly  all  of  us  in  his  professional  capacity 
and  as  a member  of  this  society,  a man 
dear  to  all  of  us  for  his  sterling  and  man- 
ly qualities.  We  bid  him  good-bye. 

Now  I come  to  the  one  that  we  miss  most 
of  all,  William  Ray  Bathurst.  Last  year 
after  the  Hot  Springs  meeting,  when  the 
exercises  were  concluded,  he  came  to  me 
and  shook  my  hand  and  said  how  glad  he 
was  to  hear  what  I had  to  say  about  those 
we  loved  and  those  whom  we  had  been  as- 
sociated with  for  so  many  years.  He  was 
the  picture  of  health.  No  one  could  have 
predicted  that  the  finger  of  Death  would 
be  upon  him  and  that  we  would  be  con- 
fronted at  this  moment  with  his  absence. 
We  are  confronted  only  with  his  memory. 
He  went,  as  we  would  all  like  to  go-,  out 
upon  the  tideless  sea  without  the  pain  and 
anguish  of  death. 

I wrote  to  three  men  whom  I believed 
to  be  his  dearest  friends,  Norwood,  Rhine- 
hart  and  Deisch.  They  answered  and  their 
answers  were  published  in  the  Memorial 
Journal  of  October  last,  dedicated  to  the 
memory  of  the  man  who  had  done  so  much 
for  the  Journal  and  for  the  profession  of 
the  state. 

Now  a few  words  for  her  who  shared 
his  life,  whose  presence  among  us  was  so 
conspicuous  at  each  meeting,  one  who 
stood  before  the  altar  and  solemnly  prom- 
ised, forsaking  all  others,  to  cleave  unto 
him  until  “death  us  do  part.”  Shall  I say 
for  her  these  closing  words : 

Upon  a tomb  in  a faraway  isle  of  the  sea 
Soft  Southern  breeze  blow  gently  here 
Warm  sun  above,  shine  bright — 

Green  sod  above,  lie  light; 

Good  night,  dear  heart,  good  night,  good 
night. 

The  President:  The  ladies  of  the  Auxil- 
iary present  this  beautiful  wreath  in  sol- 
emn memory  of  those  who  have  passed  on. 


Song:  “Crossing  the  Bar.” — Quartet. 
The  President:- In  behalf  of  the  Arkan- 
sas Medical  Society,  I wish  to  extend  a 
vote  of  thanks  to  those  who  have  assisted 
in  this  sad  but  sacred  service.  Now  I will 
ask  Dr.  Reves  to  give  the  benediction. 

Benediction. 

<§> — — . 

Commercial  Announcements 

BORDEN’S  EVAPORATED  MILK 

“Extensive  work  done  on  the  food  value  and  di- 
gestibility of  milk  has  shown  that  pasteurized 
milk,  unsweetened  evaporated  milk,  and  dried 
whole  milk  may  be  used  one  for  the  other.” 

This  interesting  and  significant  quotation  is 
taken  from  an  article  entitled  “The  Doctor  and 
the  Family  Budget”  by  Anderson  and  Gillett  in 
the  Medical  and  Professional  Woman’s  Journal 
for  March,  1934.  The  authors  point  out  that 
standard  evaporated  milk  can  be  obtained  at  low 
cost,  the  savings  on  this  high  quality  -product 
often  being  the  means  of  supplying  the  family 
with  other  necessary  protective  foods. 

Physicians  know  that  the  advantages  of  evap- 
orated milk  have  been  amply  demonstrated  by 
clinical  research  and  experience.  In  recommend- 
ing an  evaporated  milk,  however,  it  is  desirable 
to  specify  an  outstanding  brand,  such  as  Borden’s, 
in  order  that  patients  will  be  assured  of  the  pro- 
duct that  will  give  the  utmost  satisfaction  to  them 
as  well  as  to  the  physician. 

< 

SUMMER  DIARRHEA  IN  BABIES 

Casec  (calcium  caseinate),  which  is  almost 
wholly  a combination  of  -protein  and  calcium,  of- 
fers a quickly  effective  method  of  treating  all 
types  of  diarrhea,  both  in  bottle-fed  and  breast- 
fed infants.  For  the  former,  the  carbohydrate 
is  temporarily  omitted  from  the  24-hour  formula 
and  replaced  with  8 level  tablespoonfuls  of  Casec. 
Within  a day  or  two  the  diarrhea  will  usually 
be  ai'rested,  and  carbohydrate  in  the  form  of 
Dextri-Maltose  may  safely  be  added  to  the  for- 
mula and  the  Casec  gradually  eliminated.  Three 
to  six  tablespoonfuls  of  a thin  paste  of  Casec  and 
water,  given  before  each  nursing,  is  well  indicated 
for  loose  stools  in  breast-fed  babies.  Please  send 
for  samples  to  Mead  Johnson  & Company,  Evans- 
ville, Indiana. 

Tablets  Calcium  Phosphate  Compound  with  Vi- 
osterol — 10  D Squibb  is  a new  professional  spec- 
ialty that  is  now  being  marketed  by  E.  R.  Squibb 
& Sons.  Each  tablet  contains  9 grains  Dicalcium 
Phosphate,  6 grain  Calcium  Gluconate  and  245 
Steenbock  units  of  Vitamin  D.  These  tablets 
supply  calcium  and  phosphorus  in  approximate- 
ly optimum  ration  (i.  e.,  1 to  1.625)  and  ample 
Vitamin  D to  facilitate  their  absorption  and  util- 
ization. 

Tablets  Calcium  Phosphate  Compound  with  Vi- 
osterol — 10  D Squibb  are  indicated  for  the  wide 
variety  of  conditions  which  may  be  benefited  by 
ca’cium  administration.  The  tablets  are  flavored 
with  wintergreen  and  when  chewed  have  a very 
pleasant  taste.  They  are  marketed  in  bottles  of 
50  tablets. 


26 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  1 


Book  Reviews 


Treatment  In  General  Practice.  By  Harry  Beck- 
man, M.  D.,  Professor  of  Pharmacology  at  Mar- 
quette University,  School  of  Medicine,  Milwaukee, 
Wisconsin.  Second  edition,  revised  and  entirely 
reset.  889  pages.  Philadelphia  and  London:  W. 
B.  Saunders  Company,  1934.  Cloth  $10.00  net. 

This  book  was  first  published  in  1930  and  its 
popularity  was  such  that  it  was  reprinted  five 
times  and  in  1934  it  was  decided  to  completely 
rewrite  the  book.  Beckman’s  book  is  unique  in 
that  Beckman  has  the  happy  and  rare  faculty  of 
entertaining  you  while  he  instructs  you.  His  book 
not  only  tells  you  all  that  is  necessary  to  know 
about  the  treatment  of  the  various  diseases  en- 
countered in  general  practice  but  he  tells  it  to 
you  in  such  an  entertaining  manner  and  his  liter- 
ary style  is  so  pleasing  that  one  reads  on  and 
on  from  the  sheer  pleasure  of  reading. 

This  new  1934  edition  is  most  complete  and 
comprehensive.  In  his  own  inimitable  style  Beck- 
man gives  you  the  accepted,  up-to-the-minute 
methods  of  treatment  and  then  he  gives  you  his 
own  ideas  and  his  own  experiences  which  not  in- 
frequently differ  from  opinions  held  by  others, 
but  he  leaves  you  the  right  of  choice.  The  sections 
on  amebic  dysentery,  diabetes,  and  allergic  con- 
ditions are  especially  complete,  comprehensive, 
and  charmingly  written.  I think  I am  safe  in 
saying  that  there  is  no  book  in  print  today  which 
combines  more  skillfully  the  best  and  latest  ideas 
on  the  treatment  of  disease  with  a literary  style 
that  makes  the  absorption  of  these  ideas  easy 
and  pleasant. 


Surgical  Clinics  of  North  America.  (Philadel- 
phia number — Feb.  1934).  Volume  14,  Number 
1.  226  pages  with  62  illustrations.  Per  Clinic 

year,  published  bi-monthly,  paper  $12.00,  cloth 
$16.00.  Philadelphia,  W.  B.  Saunders  Co.,  1934. 

This,  the  Philadelphia  number,  contains  many 
valuable  and  interesting  observations  in  surgical 
conditions.  Among  the  most  interesting  is  the 
first  in  this  issue  by  Eliason  and  McLaughlin  on 
pulmonary  complications  following  operations. 
They  have  noted  that  atelectasis  is  the  second 
largest  in  their  series  of  cases.  They  believe 
that  the  percentage  is  larger  than  is  suspected 
in  previous  reports  because  it  has  not  been  looked 
for.  Jackson  reports  several  cases  of  laryngeal 
stenosis  and  ends  with  this  admonition  that  sim- 
ply “doing  a largynostomy”  for  stenosis  is  worse 
than  useless.  A very  interesting  symposium*  is 
presented  by  Shallow,  Clerf  and  Manges  on  for- 
eign bodies  in  the  gastro-intestinal  tract.  Among 
other  interesting  observations  were  the  relief  of 
intestinal  obstruction  by  hydraulic  aspiration,  rec- 
tal drainage  of  pelvis  abscesses  in  the  male  and 
differential  diagnosis  of  gall  bladder  diseases. 


The  Sputum:  Its  Examination  and  Clinical  Sig- 
nificance. Randall  Clifford,  M.  D.,  F.  A.  C.  P., 
Associate  in  Medicine,  Peter  Bent  Brigham  Hos- 
pital, etc.  167  pages,  21  figures,  7 plates  in  col- 
ors. New  York:  The  MacMillan  Company,  1932. 
Price  $4.00. 

This  is  a complete  practical  guide  to  the  exam- 


ination of  the  sputum,  giving  all  technical  meth- 
ods and  discussing  the  character  and  clinical  sig- 
nificance of  the  sputum  in  some  of  the  more  com- 
mon diseases  of  the  lungs  and  bronchi. 


General  Surgery.  The  1933  Yearbook,  Practical 
Medicine  Series.  Edited  by  Evarts  A.  Graham, 
A.  B.,  M.  D.,  Professor  of  Surgery,  Washington 
University  School  of  Medicine,  Saint  Louis.  The 
Year  Book  Publishers,  Chicago,  1933. 

All  outstanding  work  of  the  year  is  reviewed 
in  the  826  pages  of  this  volume.  The  literature 
indicates  that  ether  remains  the  safest  anesthetic 
for  general  use.  Thoracic  surgery  is  thoroughly 
presented  with  its  many  advances.  Special  at- 
tention is  directed  to  the  superiority  of  iodine  over 
modern  antiseptics,  and  to  the  results  obtained 
by  Pannewitz  in  the  treatment  of  1,500  eases  of 
arthritis  deformans  by  X-ray.  Several  cases  of 
bypoglcemia  produced  by  adenomas  of  the  pan- 
creatic islet  tissue  are  reported.  The  surgeon  and 
the  general  practitioner  will  find  many  diagnos- 
tic points  as  well  as  abstracts  not  readily  acces- 
sible in  this  volume. 


Light  Therapy.  By  Frank  H.  Krusen,  Director 
of  the  Department  of  Physical  Medicine,  Temple 
University  School  of  Medicine,  Philadelphia.  Pp. 
186,  with  33  illustrations.  Price  $3.50.  New 
York:  Paul  B.  Hoeber,  Inc.,  1933. 

Many  physicians  seem  to  believe  that  if  they 
possess  a lamp  which  is  labelled  an  ultraviolet 
or  sun-lamp  that  it  will  produce  ultra-violet  rays, 
and  that  these  rays  will  accomplish  practically 
any  desired  anti-rachitic  or  bactericidal  effect 
which  is  required.  More  careful  study  has  shown 
that  these  sources  vary  widely  in  the  results  and 
that  it  is  necessary  to  have  certain  portions  of 
the  light  spectrum  in  proper  intensity  produced 
by  the  agency  to  obtain  the  desired  physiological 
effect.  To  practice  light  therapy  intelligently, 
the  physician  should  be  acquainted  with  the  phys- 
ical properties  of  the  lamp  which  he  is  using  as 
well  as  possessing  a knowledge  of  the  results 
which  imay  be  expected  on  the  tissues.  Light 
therapy  has  been  applied  too  frequently  in  an 
empiric  manner  with  no  recognition  of  the  dan- 
gers which  are  present.  In  this  volume  the  author 
has  presented  a differentiation  of  fact  and  fancy 
with  a serviceab’e  technic.  The  dangers,  limita- 
tions and  indications  are  fully  discussed.  The 
reviewer  feels  that  this  is  the  most  valuable  book 
on  the  subject  yet  to  appear. 


Clinical  Endocrinology  of  the  Female.  By 
Charles  Mazer,  M.  D.,  F.  A.  C.  S.,  Assistant  Pro- 
fessor of  Gynecology  and  Obstetrics,  Graduate 
School  of  Medicine,  University  of  Pennsylvania, 
and  Leopold  Goldstein,  M.  D.,  Demonstrator  of 
Obstetrics,  Jefferson  Medical  College.  Pp.  519, 
with  117  illustrations.  Price  $6.  Philadelphia 
and  London:  W.  B.  Saunders  Company,  1932. 

This  volume  primarily  concerns  itself  with  men- 
struation and  its  disorders.  The  growth  promot- 
ing and  gonad  stimulating  functions  of  the  pitui- 
tary are  fully  discussed.  Sterility,  pregnancy 
tests,  obesity  and  lactation  receive  separate  chap- 
ters. Numerous  case  reports  supplement  the 
treatise,  unique  of  its  kind. 


The  Secretary  of  the  County  Society  will  please  notify  the  State  Secretary  immediately  of  any 

error  or  change  in  these  officers. 


COUNTY  SOCIETIES 

OF  THE 


ARKANSAS  MEDICAL  SOCIETY, 

1934 

COUNTY 

PRESIDENT 

ADDRESS 

SECRETARY 

ADDRESS 

AJRKANSAS 

Stuttgart  

ASHLEY  - - - - 

. W.  S.  Norman  - 

_ Hamburg 

BENTON- 

C.  S.  Wilson  . 

Siloam  Springs  .. 

E.  A.  Pickens  . _ 

BOONE . 

D.  L.  Owens 

Harrison 

W.  H.  Poynor 

BRADLEY  

C.  N.  Martin 

. Warren  

CARROLL 

D.  K.  McCurry  __ . 

Green  Forest 

CHICOT . 

J.  H.  Burge  

.Lake  Village 

...A.  J.  Paulf 

- .Lake  Village 

CLARK  

- Arkadelphia 

OLAY 

J.  P.  Hiller 

_ ....  Pollard 

_ J.  E.  McGuire 

CLEVELAND  ... 

Rison - 

COLUMBIA 

__G.  F.  McLeod 

. -Magnolia 

„ A.  J.  Souter 

.Waldo 

CONWAY-POPE-YELL 

L.  M.  Smith  . 

RiisraIIviIIa 

Robert  Hood 

CRAIGHEAD-POINSETT 

E.  J.  Homer  

Jonesboro  

— E.  R.  Barrett ... 

Jonesboro 

CRAWFORD 

-Odell  J.  Kirksey  . 

Mulberry 

S.  D.  Kirkland 

CRITTENDEN ... 

T S.  Hare ... 

. ...  Crawfordsville  ...  . 

...  L.  C.  McVay 

CROSS  

..Austin  Flint  Barr 

. _.  Cherry  Valley 

..  ..Ruffin  Longest 

...  . Wynne 

DALLAS  

>_H.  A.  Cheatham. 

Princeton  __ 

DESHA 

-.c.  H.  Kimbro 

Tillar  ..  ...  

DREW 

M.  Y.  Pope  - . - 

FAULKNER  

A J.  Glover 

GuY  

FRANKLIN 

__W.  H.  Gibbons 

Ozark 

GARLAND  

T.  N.  Black 

. . .Hot  Springs 

...  G.  A.  Hebert 

. ..  Hot  Springs 

GRANT  ....  . 

R.  L.  Paxton  

Sheridan 

-O.  R.  Kelly 

GREENE  

R.  J.  Halev 

_ Paragould 

HEMPSTEAD  . 

. G.  H.  Martindale  ._ 

...  . Hope  

.—  A.  C.  Kolb 

HOT  SPRING  . 

-J.  M.  Williams  

.Malvern  

....H.  L.  Brown  ...  . 

Malvern 

HOWARD-PIKE 

W.  B.  Simpson;  .... 

Nashville.  .... 

INDEPENDENCE 

. H.  H.  Brown  

..  ..  Walnut  Grove 

M.  S.  Craig 

JACKSON  . 

,.H.  O.  Walker 

Newrport 

..J.  B.  Ivy  

Tuckerman 

JEFFERSON ....  ..  . 

-B.  D.  Luck,  Sr.  . 

Pine  Bluff 

JOHNSON  

. J.  S.  Kolb 

Clarksville 

LAFAYETTE 

F.  E.  Baker 

Stamps 

LAWRENCE 

- E.  H.  Rainwater  .. 

Walnut  Ridge 

J.  C.  Land  

..  .Walnut  Ridge 

LEE  ....  . 

H.  L.  White  

Rondo  

— . N.  C.  Hodge.  . 

. ...Marianna 

LINCOLN  ...  ...  . . 

..Chas.  Wm.  Dixon 

Gould  

. ..Vernon  Tarver 

...  Star  City 

LITTLE  RIVER. 

P.  H.  Phillips  

Ashdown  . 

...J.  W.  Ringgold  . 

..  Ashdown 

LONOKE 

. J.  B.  Wells 

Scott ... 

--  O.  D.  Ward 

MADISON  . 

N.  J.  Hill  

Hindsville . 

. ..Fred  Youngblood 

.Huntsville 

MTLLER  

A.  H.  Mann 

Texarkana  .. 

—-H.  E.  Murry 

. Texarkana 

MISSISSIPPI  . 

J.  L.  Tidwell 

..  ..  Dell  _ ... 

MONROE  

W.  H.  Martin 

Holly  Grove 

MONTGOMERY  

.J.  D.  Robbins.  

....  Mt.  Ida  

— .J.  H.  McLean  

...Caddo  Gap 

NEVADA  ....  . 

Prescott ....  . 

A.  B.  Dickev  

Prescott 

OUACHITA  . . 

R.  B.  Robins . 

PHILLIPS 

W.  C.  Russwurm 

Helena  . 

POLK  . 

C.  A.  Campbell 

PRAIRIE  

W.  J.  Williams 

PULASKI  

-A.  C.  Shipp  .. 

- — -<JL  JL  CtZiLll 

RANDOLPH 

M.  A.  Baltz 

Pocahontas 

J.  R Loft  is 

SALINE  . . 

.J.  A.  Burks 

SCOTT  . 

Geo.  Holitik 

Waldron 

J_)  Lilt  U 1 1 

SEARCY  

-E.  W.  Wood 

Marshall 

SEBASTIAN 

I.  F.  Jones  ..... 

- .Fort  Smith 

SEVIER  . 

-J.  C.  Graves 

. ..Locke  sburg  _ _ 

ST.  FRANCIS  

C.  N.  Bogart 

Forrest  City 

J.  O.  Rush 

....Forrest  City 

UNION 

~L.  A.  Purifoy 

El  Dorado 

F L Trby 

WASHINGTON 

P.  L.  Hathcock 

FaycttAvillA 

WHITE  

D.  W.  Sloan 

WOODRUFF 

J F.  Hays  

..Augusta  

. L.  E.  Biles 

-Augusta 

Balyeat  Hay  Fever  ay©  Asthma 

Clinic 

OSLER  RUILDING 

OKLAHOMA  CITY,  OKLAHOMA 

DEVOTED  EXCLUSIVELY  TO  THE  DIAGNOSIS  AND  TREATMENT  OF  ALLERGIC  DISEASES 

♦ 

MEDICAL  STAFF 

Ray  M.  Balyeat,  M.  A.,  M.  D.,  F.  A.  C.  I\  Robert  L.  Howard,  M.  S.,  M.  D. 

Director  Dermatology 

Ralph  Bowen,  B.  A.,  M.  D.,  F.  A.  A.  P L.  Everett  Seyler,  B.  S.,  M.  D. 

Pediatrics  Gastroenterology 


| The  A.  S.  ALOE  CO. 

ANNOUNCES... 

DR.  CHARLES  ROBERT  ELLIOTT 
TREATMENT  MACHINE 


See  These  Articles  on  Elliott  Technic 
in  Pelvic  Inflammatory  Diseases 

Holden  and  Gurnee,  Am.  Jour.  Obs.  & Gyn.,  July, 
1931. 

Holden  and  Sovak,  Am.  Jour.  Obs.  & Gyn.,  Nov.,  1932. 
Counseller,  Jour.  A.  M.  A.,  Sept,  lfi,  1933. 

Graham,  Am.  Jour.  Surg.,  June,  1932. 

Stone,  Am.  Jour.  Physical  Therapy,  April,  1932. 
Jacobs,  St.  Louis  Med.  Soc.  Bulletin,  Discussion  by 
Vaughan  and  Gellhorn,  June  5,  1931. 

Holliday,  Jour,  of  Dental  Research,  Dec.,  1932. 
Shullman,  Jour,  of  Med.  Soc.  of  New  Jersey,  1933. 

Send  for  Descriptive  Circular  and  Price. 

A.  S.  ALOE  CO. 

1819  Olive  St.  St.  h 'uis,  Mo. 


gEVEN  YEARS’  USE 

has  demonstrated  the 
value  of 

THE  SURGICAL  SOLUTION 

of 

Mercurochrome,  H.  W.  & D. 

in 

Preoperative  Skin  Disinfection 

This  preparation  contains  2%  Mercuro- 
chrome in  aqueous-alcohol-acetone  so- 
lution and  has  the  advantages  that: 

Application  is  not  painful. 

It  dries  quickly. 

The  color  is  due  to  Mercurochrome 
and  shows  how  thoroughly  this 
antiseptic  agent  has  been  applied. 

Stock  solutions  do  not  deteriorate. 

Now  available  in  4,  8 and  16  oz.  bottles 
and  in  special  bulk  package  for  hospitals. 

LITERATURE  ON  REQUEST 

Hynson,  Westcott  & Dunning,  Inc. 

BALTIMORE,  MARYLAND 


The  Council  urges  support  of  JOURNAL  advertisers. 


THE  JOURNAL 


of  the  ARKANSAS  MEDICAL  SOCIETY 

PUBLISHED  MONTHLY  UNDER  DIRECTION  OF  THE  COUNCIL 


Vol.  XXXI 


Fort  Smith  Arkansas,  July,  1934 


No.  2 


RECENT  ADVANCES  IN  SURGERY* 

Charles  S.  Holt,  M.  D.,  F.  A.  C.  S. 

Fort  Smith 

Progress  in  surgery,  unlike  advances  in 
manufacturing,  cannot  be  expressed  in 
terms  of  labor-saving,  decreased  produc- 
tion costs,  improved  quality,  or  any  other 
unit  capable  of  immediate  estimation.  Be- 
cause of  the  peculiar  combination  of  art 
and  science  making  up  the  profession  of 
surgery,  tangible  evidence  upon  which  to 
base  an  opinion  as  to  whether  or  not  a 
given  innovation  is  a worthwhile  advance 
is  lacking.  Even  such  apparently  concrete 
factors  as  morbidity  and  mortality  are  de- 
ceptive, because  of  the  inability  of  the  sur- 
geon to  exactly  duplicate  conditions.  Gra- 
ham has  pointed  out  that  in  empyema,  the 
mortality  exactly  parallels  that  of  the  con- 
current epidemic  of  pneumonia,  which  in 
some  years  may  be  very  high,  and  in  others 
low.  A new  method  of  treatment  brought 
out  in  a year  in  which  a benign  type  of 
infection  is  present  will  show  a decreased 
mortality  rate  in  its  favor,  while  on  the 
following  year  with  a reversal  of  condi- 
tions, the  mortality  rate  may  even  exceed 
that  of  the  old  method  of  treatment. 
Therefore,  time  and  accumulated  experi- 
ence of  many  surgeons  under  a wide  va- 
riety of  conditions,  are  the  only  criteria 
upon  which  to  judge  and  are  the  basis 
upon  which  the  following  advances  have 
been  selected. 

Electro-surgery  has  come  to  assume 
such  importance  in  the  field  of  surgery  as 
to  become  almost  a specialty  in  itself,  as 
recently  emphasized  by  Foltz.  In  some 
instances  it  has  opened  doors  previously 
closed  to  the  surgeon.  Many  cases  of  brain 
tumors,  previously  considered  inoperable 
after  exploration,  sue  has  the  old  factory 

(* — Read  before  the  Fifty-ninth  Annual  Ses- 
sion of  the  Arkansas  Medical  Society,  held  in 
Little  Rock,  April  16,  17,  18,  1934.) 


groove  meningiomas,  are  today  returning 
for  complete  extirpation  of  the  growth, 
made  technically  possible  by  electro-sur- 
gical methods.  All  brain  surgery  has  been 
greatly  simplified  by  this  new  weapon. 
On  theoretical,  and  sometimes  on  techni- 
cal grounds,  electro-surgery  is  the  best 
method  we  have  for  the  solution  of  the 
problem  of  malignant  disease.  The  Sturm- 
dorff  technique  for  chronic  endocervicitis 
is  too  difficult  for  universal  application, 
and  radial  cauterization  does  not  always 
cure.  Conization  of  the  cervix  by  high  fre- 
quency methods  is  simple,  and  removes  all 
gland  bearing  areas  without  danger  of 
hemorrhage  or  subsequent  stenosis  of  the 
canal. 

The  treatment  of  prostatic  obstruction 
has  undergone  a radical  change  during  the 
past  two  years.  The  development  of  trans- 
urethral resection,  originally  brought  out 
for  median  bar  obstruction,  and  made  pos- 
sible by  electro-surgery,  bids  fair  to  ren- 
der the  operation  of  prostatectomy  obso- 
lete. In  520  cases  of  prostatic  obstruction 
treated  at  the  Mayo  Clinic  in  1933,  only 
seven  prostatectomies  were  done,  the  re- 
mainder being  relieved  by  trans-urethral 
methods.  Hospitalization  of  the  patient  is 
reduced  to  five  days,  and  the  mortality  is 
distinctly  lower,  particularly  in  the  poor 
risk  type  of  patient  as  are  most  of  these 
cases.  Since  there  is  no  satisfactory  radi- 
cal treatment  for  carcinoma  of  the  pros- 
tate at  the  present  time,  transurethral  re- 
section is  the  best  method  of  approach,  of- 
fering a comfortable  and  symptom-free 
existence  to  these  unfortunate  victims  for 
from  five  to  eight  years. 

Thorek  has  recently  described  another 
adaption  of  electro-surgery  in  the  treat- 
ment of  gall  bladder  disease  under  the 
term  of  “Cholecystelectrocoagulectomy.” 
The  portion  of  gall  bladder  normally  ad- 
herent to  the  liver  is  allowed  to  remain 
after  the  free  portion  is  resected,  and  the 


28 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  2 


mucosa  destroyed  by  coagulation.  This 
area  is  then  covered  over  with  the  falci- 
form ligament  and  the  wound  closed  with- 
out drainage.  In  his  series  of  unselected 
cases  treated  in  this  manner  the  mortality 
has  been  zero. 

Anesthesia 

That  the  ideal  anesthetic  has  not  yet 
been  found  is  shown  by  the  great  amount 
of  research  work  being  done  in  this  field. 
Spinal  anesthesia  has  been  widely  adopt- 
ed, and  the  procedure  standardized.  In 
general  use  it,  however,  still  carries  with 
it  a higher  mortality  rate  than  ether,  and 
certain  untoward  late  results  are  being 
reported  with  increasing  experience.  An 
agent  which  is  achieving  an  increasing 
popularity  is  tribrom-ethanol  or  Avertin. 
Our  own  personal  experience  with  450 
cases,  without  fatality  or  bad  result,  has 
convinced  us  of  its  safety  and  usefulness. 
While  used  only  as  a basal  anesthetic,  the 
avoidance  of  preoperative  excitement,  the 
decrease  in  postoperative  vomiting  and 
respiratory  complications  has  materially 
contributed  to  the  comfort  of  the  patient. 
Divinyl  ether  has  been  brought  out,  but 
so  far  the  clinical  application  is  in  the  ex- 
perimental stage.” 

Surgery  of  the  Eye 

The  dreaded  condition  of  detachment  of 
the  retina,  formerly  leading  to  hopeless 
blindness,  has  been  cured  in  a large  num- 
ber of  cases  by  the  spectacular  and  in- 
genious operation  recently  devised  by  Sa- 
far  in  which  the  retina  is  reattached  by 
coagulation  of  multiple  small  areas  by 
diathermy. 

Thoracic  Surgery 

Important  advances  in  thoracic  surgery 
have  been  made  possible  by  development 
of  new  anesthetics,  as  avertin,  and  by  the 
intratracheal  administration  of  ether.  Har- 
rington reports  a series  of  38  cases  of 
tumors  of  the  mediastinum  successfully  re- 
moved surgically  by  the  use  of  intratra- 
cheal anesthesia  under  pressure.  Inasmuch 
as  78  per  cent  of  these  tumors  were  be- 
nign, a large  proportion  of  permanent 
cures  resulted. 

Considerable  progress  has  been  made  in 
the  surgical  treatment  of  pulmonary  tu- 
berculosis during  the  past  year,  both  in 


the  standardization  of  indications  and 
technique,  as  well  as  in  the  evaluation  of 
end-results.  Nehil  and  Alexander  report 
302  cases  in  which  phrenicectomy  alone 
was  used  and  found  of  this  number  34 
per  cent  cured  or  arrested  and  35  per  cent 
improved.  Of  1,897  cases  collected  by 
them  from  the  literature  60.5  per  cent  were 
cured  or  improved,  corresponding  to  the 
figures  reported  by  Krock  in  1933.  There 
is  a growing  tendency  to  substitute  phre- 
nicectomy for  artificial  pneumothorax  be- 
cause of  the  necessity  for  frequent  repe- 
tition over  a long  period  of  time  in  the  lat- 
ter. Thoracoplasty  is  being  used  more  fre- 
quently in  the  poor  risk  type  of  patient  by 
the  use  of  multiple  stage  procedures.  A 
number  of  bilateral  phrenicectomies  have 
been  reported  with  good  results  particu- 
larly in  the  childhood  type  of  infection. 
Graham  has  successfully  accomplished  a 
bilateral  thoracoplasty.  Scaleniotomy  as 
an  accessory  to  phrenic  exeresis  has  grown 
in  favor,  particularly  in  upper  lobe  cavia- 
tion. 

Graham  reported  the  first  case  in  which 
an  entire  lung  has  been  removed  success- 
fully in  one  stage  for  carcinoma  of  the 
bronchus.  Six  successful  cases  are  record- 
ed in  the  literature  in  which  part  of  a lung 
has  been  removed,  and  an  equal  number  in 
which  the  growth  has  been  removed  by 
bronchoscopy.  Graham  calls  attention  to 
the  increasing  frequency  of  primary  car- 
cinoma of  the  lung,  at  present  constitut- 
ing between  5 and  10  per  cent  of  all  car- 
cinomas, and  offers  this  method  of  treat- 
ment as  an  attack  upon  the  present  mor- 
tality of  almost  100  per  cent  associated 
with  the  lesion.  If  this  operation  proves 
feasible  in  selected  cases,  it  is  probable  that 
many  patients  might  be  saved  who  would 
otherwise  die  from  carcinoma  of  the  lung. 

Fractures 

There  has  been  an  increasing  tendency 
to  treat  fractures  by  the  use  of  skeletal 
traction,  employing  the  Steinman  pin  or 
Kirschner  wire,  and  often  incorporating 
it  in  the  cast.  Anderson  has  described  a 
method  for  utilizing  the  well  leg  for  coun- 
ter traction  which  is  particularly  applica- 
ble to  fractures  of  the  hip.  By  this  method 
hospitalization  is  shortened,  massage  and 
active  and  passive  movements  permitted, 
circulatory  and  respiratory  complications 


July,  1934] 


ARKANSAS  MEDICAL  SOCIETY 


29 


avoided,  especially  advantageous  to  the 
aged  in  whom  these  fractures  are  usually 
found. 

Experience  with  manipulative  reduction 
of  compressive  fractures  of  the  spine  fol- 
lowed by  the  application  of  a cast  and 
graded  exercises  has  shown  that  the  dis- 
ability ordinarily  incident  to  such  an  acci- 
dent can  be  greatly  reduced,  and  in  many 
cases  the  compressed  and  deformed  ver- 
tebra restored  to  an  approximately  nor- 
mal shape.  Boehler  feels  that  every  com- 
pression fracture  less  than  two  weeks  old 
can  be  satisfactorily  reduced,  and  that 
prolonged  immobilization  of  such  fractures 
without  preliminary  reduction  is  to  be 
condemned.  He  allows  his  patients  to  be 
up  within  one-half  day  after  application 
of  the  cast. 

Sympathetic  Nervous  System 

Considerable  work  has  been  done  on  es- 
tablishing the  relationship  of  the  sympa- 
thetic nervous  system  to  the  so-called  func- 
tional disorders.  Interest  has  increased 
in  Cotte’s  operation  which  consists  of  the 
resection  of  the  postganglionic  fibres  of 
the  sympathetic  system  supplying  the  pel- 
vic organs  as  a method  of  relief  for  severe 
dysmenorrhea,  intractable  pain  associated 
with  inoperable  carcinoma,  and  various 
disturbances  of  bladder  function.  The 
anatomy  of  these  nerves  has  been  well  de- 
scribed by  Elaut.  Increasing  satisfaction 
with  the  results  obtained  by  sympathec- 
tomy in  the  treatment  of  peripheral  vascu- 
lar diseases  of  the  spastic  type  is  reflected 
in  the  surgical  literature. 

Crile  has  reported  the  results  of  several 
hundred  denervations  of  the  adrenal 
glands  with  striking  success  in  peptic  ul- 
cer, exophthalmic  goitre,  neuro-circula- 
tory  asthenia,  and  a few  cases  of  diabetes 
mellitus.  The  results  have  been  negative 
in  essential  hypertension,  Raynaud’s  dis- 
ease, and  in  the  true  types  of  neurasthe- 
nia. Better  ultimate  results  are  obtained 
with  this  operation  than  by  thyroidectomy 
in  toxic  goitre  except  in  those  cases  too 
toxic  to  stand  this  procedure. 

Endocrine  System 

The  major  development  of  surgery  dur- 
ing 1933  has  been  in  the  field  of  the  en- 
docrine system.  Our  attitude  toward  dis- 


ease is  changing  from  the  etiological  basis 
of  pathological  anatomy  to  one  of  patho- 
logical physiology,  as  our  knowledge  in 
this  confusing  field  has  been  systematized, 
and  the  various  syndromes  classified  by 
the  painstaking  work  of  endocrinologists, 
and  research  workers  in  experimental  phy- 
siology. 

Holman  and  Railsback  reviewed  the 
literature  of  cases  of  hyperinsulinism 
treated  surgically,  and  added  their  own 
case  which  was  materially  improved  by 
partial  resection  of  the  pancreas.  Gra- 
ham also  reported  a successful  case.  The 
trend  is  to  urge  exploration  in  these  in- 
stances of  spontaneous  hypoglycemia  be- 
cause of  the  frequent  finding  of  adeno- 
mata of  the  islands  of  Langerhans  in  the 
pancreas. 

Another  characteristic  syndrome  is  the 
change  in  secondary  sexual  characteristics, 
with  virilism,  excessive  growth  of  hair, 
amenorrhea,  and  abnormal  deposits  of  fat 
over  the  body.  This  has  been  found  to  be 
associated  with  tumors  of  the  adrenal  cor- 
tex by  Walters,  with  basophilic  adenomata 
of  the  pituitary  by  Cushing,  and  with  a 
peculiar  tumor  of  the  ovary,  known  as  the 
arrhenoblastoma,  by  Meyer,  and  Taylor, 
Wolferman  and  Krock.  In  all  these  in- 
stances, removal  of  the  involved  gland  has 
resulted  in  a spectacular  return  to  normal 
of  the  affected  individual.  An  evolution 
of  our  concept  of  the  etiology  of  diabetes 
mellitus  from  the  older  idea  of  a deficien- 
cy of  the  islands  of  Langerhans  to  the 
newer  theory  of  an  over-production  of  an 
anterior  pituitary  hormone,  antagnostic  to 
insulin,  is  in  evidence  in  recent  publica- 
tions, and  may  form  the  basis  of  surgical 
methods  of  treatment  of  this  disease  in 
the  future. 

New  Suture  Materials 

Koontz  reported  the  use  of  Gaillie’s 
technique  in  the  repair  of  large  postoper- 
ative or  recurrent  hernias,  but  has  substi- 
tuted alcohol-preserved  ox  fascia  lata  for 
the  living  sutures  of  autogenous  fascia  lata 
strips  introduced  by  Gaillie.  This  mate- 
rial is  now  available  in  the  form  of  strips 
or  wide  sheets  from  several  suture  manu- 
facturers. The  above  author  advises  the 
use  of  silk  or  linen  in  tying  down  the  edges, 
and  stab  wound  drainage  to  prevent  the 


30 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  2 


accumulation  of  serum  in  the  wound. 
Lowsley  has  introduced  ribbon  cat  gut  for 
use  in  the  repair  of  kidney  wounds,  par- 
ticularly those  made  when  the  kidney  is 
split  open  for  the  removal  of  large  stones. 
Experimental  and  clinical  evidence  are  in 
accord  that  such  material  effects  better 
hemostasis,  more  accurate  approximation 
of  edges,  and  more  rapid  healing. 

Treatment  of  Peritonitis 

The  tragedy  of  an  increasing  death  rate 
from  appendicitis  still  offers  a challenge 
to  surgery.  As  yet  this  challenge  goes 
unanswered.  Campaigns  of  education, 
such  as  carried  out  by  the  Philadelphia 
Board  of  Health,  in  warning  the  public 
against  the  promiscuous  use  of  cathartics 
in  abdominal  pain,  and  the  dangers  of  de- 
lay in  seeking  medical  advice,  have  been 
rewarded  by  some  reduction  of  mortality 
from  this  cause  in  this  particular  city. 

Orr  has  recently  shown  experimental 
evidence  to  prove  that  the  older  idea  that 
morphine  acted  as  a splint  for  the  intes- 
tines is  fallacious.  His  work  indicates 
that  it  stimulates  the  tone,  rhythmic  con- 
tractions, and  peristaltic  waves  of  the  in- 
testine for  a period  of  six  hours  following 
its  administration.  It  is  therefore  of  ben- 
efit in  the  treatment  of  acute  peritonitis 
by  preventing  overdistention  of  the  intes- 
tine (which  factor  is  largely  responsible 
for  the  toxemia)  until  the  natural  defen- 
sive powers  of  the  body  can  overcome  the 
infection.  The  maximum  benefits  can  only 
be  realized  by  giving  morphine  in  suffi- 
cient dosage  to  produce  narcosis.  Further 
adjuncts  recommended  are  the  use  of  the 
nasal  tube  of  the  Robins  type,  with  the 
application  of  continuous  suction  to  assist 
in  the  evacuation  of  gas  and  liquids  from 
the  small  intestine. 

Organ  Transplants 

During  the  past  year  work  has  been 
presented  by  Stone  and  co-workers  which 
has  such  a far-reaching  significance  as 
to  make  it  apparently  one  of  the  most 
notable  advances  in  the  field  of  surgery 
since  the  development  of  aseptic  technique. 
We  refer  to  his  method  of  transplanting 
living  grafts  of  endocrine  glands.  The 
large  group  of  disturbances  due  to  endo- 
crine deficiencies,  such  as  myxedema,  dia- 
betes mellitus,  parathyroid  tetany,  and 


Addison’s  disease,  which  are  at  present 
treated  medically  may  become  amenable  to 
surgery.  In  this  work,  numerous  obsta- 
cles had  to  be  overcome;  such  as  sur- 
rounding the  transplant  with  a suitable 
nutrient  medium,  providing  adequate  cir- 
culation for  each  cell,  and  lastly  protecting 
the  graft  from  necrosis  due  to  the  pres- 
sure of  surrounding  tissue  and  infection. 
The  latter  difficulty  has  been  solved  by 
using  the  loose  areolar  tissue  of  the  axilla 
or  groin  as  the  bed  for  the  transplant.  The 
gland  to  be  transplanted  is  cut  into  tiny 
segments  one-half  mm.  in  diameter,  and 
grown  in  a culture  media  containing  beef 
embryo  juice,  artificial  serum  saline,  se- 
rum first  from  donor,  and  then  from  re- 
cipient, and  in  heparinized  plasma  for  one 
month.  The  culture  is  changed  to  a fresh 
media  every  3-4  days  and  gradually  en- 
larges. It  is  then  clotted  on  to  a fine  silk 
thread  which  is  used  to  draw  the  mass  of 
tissue  into  the  site  of  implantation,  and 
tied  to  hold  it  in  position. 

Two  clinically  successful  cases  of  para- 
thyroid transplantation  for  tetany  have 
been  reported,  with  complete  cure  of  the 
patients’  symptoms  and  restoration  of  the 
blood  calcium  from  a low  volume  to  nor- 
mal. The  grafts  are  still  functioning  in 
one  case  seven  months,  and  in  the  other 
11  months.  While  this  work  has  been 
limited  to  animal  experimentation  with 
thyroid  and  parathyroid  transplants,  and 
parathyroid  transplants  in  the  human,  an 
unlimited  field  is  apparently  opened  for 
scientific  research,  and  future  develop- 
ment of  surgery,  as  modifications  of  this 
culture  method  are  worked  out  for  the 
other  endocrine  glands,  and  even  other  or- 
gans. It  is  even  possible  that  we  are  now 
upon  the  threshhold  of  the  door  of  the 
“fountain  of  youth.” 

In  the  few  minutes  at  our  disposal,  it 
has  been  impossible  to  give  more  than  the 
briefest  bird’s  eye  view  of  the  enormous 
volume  of  contributions  to  surgery  during 
the  past  year.  We  have  tried  to  pick  a few 
representative  examples  from  the  various 
fields  to  illustrate  a changing  trend  of 
thought,  which  after  all  is  the  only  basis 
upon  which  to  judge  an  advance  in  the 
treatment  of  as  complex  and  ever-varying 
machine  as  man. 


July,  1934] 


ARKANSAS  MEDICAL  SOCIETY 


31 


BIBLIOGRAPHY 

Anderson,  Roger:  New  method  for  treating 

Fractures,  utilizing  the  well  Leg  for  Counter- 
traction. Surg.  Gynec.  and  Obst.  1932;  54;  207. 

Boehler,  Lorenz:  Further  Experience  with  the 

Treatment  of  Vertebral  fractures.  Archiv.  fur 
klinische  Chirurgie.  1933;  177;  424. 

Cotte,  G. : Troubles  fonctionels  de  l’appariel 

genital  de  la  femme,  1931;  Paris.  Masson  et  cie. 

Cushing,  Harvey:  The  Basophilic  Adenomas 

of  the  Pituitary  and  their  Clinical  Manifesta- 
tions. Bull.  Johns  Hopkins  Hosp.  1932;  50;  137. 

Cushing,  Harvey:  “Dyspituitarism”:  Twenty 

Years  later.  Arch.  Int.  Med.  1933;  51;  487. 

Crile,  George:  Denervation  of  Adrenal  Glands 

for  Neuro  Circulatory  asthenia;  Technique  and 
Clinical  results.  Surg.  Gynec.  and  Obst.  1932; 
54;  294. 

Elaut,  L. : The  Surgical  Anatomy  of  the  so- 

called  Presacral  Nerve.  Surg.  Gynec.  and  Obst. 
1932;  55;  581. 

Foltz,  J.  A.:  The  Present  Status  and  Future 

Possibilities  of  Electro-surgery.  Jour.  Ark.  Med. 
Soc.  1933;  30;  82. 

Graham,  E.  A.  and  Womack,  N.  A.:  The  Ap- 

plication of  Surgery  to  the  Hypoglycemic  State 
due  to  Islet  Tumors  of  the  Pancreas  and  other 
Conditions.  Surg.  Gynec.  and  Obst.  1933;  56; 
728. 

Graham,  E.  A.  and  Singer,  J.  J. : Successful 

Removal  of  an  Entire  Lung  for  Carcinoma  of  the 
Bronchus.  J.  A.  M.  A.  1933;  101;  1371. 

Harrington,  S.  W. : The  Surgical  Treatment 

of  Mediastinal  Tumors.  Ann.  Surg.  1932;  96; 
843. 

Holman,  Emile  and  Railsback,  0.  C.:  Partial 

Pancreatectomy  in  Chronic  Spontaneous  Hyperly- 
cemia.  Surg.  Gynec.  and  Obst.  1933;  56;  591. 

Koontz,  A.  R. : Preserved  Fascia  in  Hernia 

Repair  with  special  reference  to  large  Postopera- 
tive Hernias.  Arch.  Surg.  1933;  26;  500. 

Krock,  Fred:  Indications  for  Surgery  in  the 

Treatment  of  Pulmonary  Tuberculosis.  Jour.  Ark. 
Med.  Soc.  1933;  29;  181. 

Lowsley,  O.  S.  and  Bishop,  C.  C. : A new  Meth- 
od of  Repairing  Kidney  Wounds.  Surg.  Gynec. 
and  Obst.  1933;  57;  494. 

Meyer,  R.:  The  Pathology  of  Some  Special 

Ovarian  Tumors  and  their  Relationship  to  Sec- 
ondary Sexual  Characteristics.  Am.  J.  Obst.  and 
Gynec.  1931;  22;  697. 

Nehil,  L.  W.  and  Alexander,  John:  An  esti- 

mate of  the  Value  of  Phrenic  Nerve  Interruption 
for  pothisis  based  upon  654  cases.  Jour.  Thor. 
Surg.  1933;  2;  549. 

Orr,  T.  G. : The  Action  of  Morphine  on  the 

Small  Intestine  and  its  clinical  application  in  the 
Treatment  of  Peritonitis  and  Intestinal  Obstruc- 
tion. Ann.  Surg.  1933;  98;  835. 

Robins,  R.  B.:  Conservative  Treatment  of  Per- 
itonitis. Jour.  Ark.  Med.  Soc.  1932;  29;  85. 

Safar,  K. : Behandlung  der  Netzhautabhebung 

mit  multiper  diatherischer  Stichelung.  1933;  S. 
Karger,  Berlin. 


Stone,  H.  B.,  Owings,  J.  C.  and  Grey,  G.  O.:  Liv- 
ing Grafts  of  Endocrine  Glands.  Cal.  and  West. 
Med.  1933;  38;  39. 

Stone,  H.  B. : Personal  communication. 

Taylor,  J.  M.,  Wolferman,  S.  J.  and  Krock, 
Fred:  Arrhenoblastoma  of  the  Ovary.  Surg. 

Gynec.  and  Obst.  1933;  56;  1040. 

Thorek,  Max. : Cholecysteledtrocoagulectomy 

without  Drainage  in  the  Treatment  of  Gall  Blad- 
der Disease.  111.  Med.  Jour.  Nov.  1933. 

Thorek,  Max.:  Personal  communication. 

Walters,  Waltman:  The  Surgical  Aspects  of 

Suprarenal  abnormalities.  Proc.  of  the  Staff 
Meetings  of  the  Mayo  Clinic.  1933;  8;  108. 
$ 

The  importance  of  milk  as  part  of  the  dietary  in 
post-operative  and  convalescent  cases  cannot  be 
over-estimated.  It  is — and  rightly  so — the  prin- 
ciple dependence  of  the  diet. 

But  many  patients  have  a natural  dislike  for 
milk,  and  others  soon  grow  tired  of  the  monot- 
ony of  milk.  . . milk  . . . milk  . . . day  after  day. 

There  is  a way,  however,  in  which  the  modern 
physician  can  overcome  this  aversion  to  milk — 
this  distaste  for  a steady  milk  diet  The  thing  to 
do  is  to  flavor  the  milk  in  a way  that  makes  the 
color  and  taste  interesting  and  inviting  to  the  pa- 
tient, yet  does  not  alter  the  basic  fundamentals 
of  the  milk  itself. 

Cocomalt,  for  example,  converts  milk  into  a 
delicious  chocolate  flavor  food-drink  that  is  tempt- 
ing to  the  fussiest  invalid.  Even  those  who  acute- 
ly dislike  milk  and  refuse  to  drink  it,  welcome 
the  refreshing  flavor  of  Cocomalt.  Not  only  does 
it  tempt  the  sick  and  lagging  appetites  by  its 
palatability : Cocomalt  substantially  increases  the 
nutritive  value  of  milk.  Every  cup  or  glass  of 
Cocomalt  a patient  drinks  (made  as  directed)  is 
equal  in  food-energy  value  to  almost  two  glasses 
of  milk  alone. 

Furthermore,  Cocomalt  does  not  tax  the  diges- 
tion. It  can  be  taken  frequently.  It  is  easily 
digested  and  quickly  assimilated  even  by  those 
whose  digestive  systems  are  impaired.  Cocomalt 
contains,  also,  a rich  supply  of  Sunshine  Vitamin 
D and  is  accepted  by  the  American  Medical  Asso- 
ciation, Committee  on  Foods. 

<$> 

SUMMER  DIARRHEA  IN  BABIES. 

Casec  (calcium  caseinate),  which  is  almost 
wholly  a combination  of  protein  and  calcium,  of- 
fers a quickly  effective  method  of  treating  all 
types  of  diarrhea,  both  in  bottle-fed  and  breast- 
fed infants.  For  the  formei',  the  carbohydrate  is 
temporarily  omitted  from  the  24-hour  formula 
and  replaced  with  8 level  tablespoonfuls  of  Casec. 
Within  a day  or  two  the  diarrhea  will  usually  be 
arrested,  and  carbohydrate  in  the  form  of  Dextri- 
Maltose  may  safely  be  added  to  the  formula  and 
the  Casec  gradually  eliminated.  Three  to  six  tea- 
spoonfuls of  a thin  paste  of  Casec  and  water, 
given  before  each  nursing,  is  well  indicated  for 
loose  stools  in  breast-fed  babies.  Please  send  for 
samples  to  Mead  Johnson  & Company,  Evansville, 
Indiana. 


32 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  2 


RECENT  PROGRESS  IN  GENERAL 
MEDICINE* 

S.  C.  Fulmer,  M.  D. 

Little  Rock 


As  one  stands  at  a distance  watching 
the  course  of  a great  river,  he  gains  an 
impression  that  the  water  is  not  moving. 
But  if  he  goes  closer  and  looks  at  objects 
floating  on  the  surface  of  the  water,  he  i£ 
immediately  impressed  by  the  constant, 
steady,  and  often-times,  the  rapid  flow  of 
the  stream. 

And  so  it  is  with  general  medicine.  As 
the  physician  goes  about  his  daily  work, 
straying  too  far  from  the  stream  of 
medical  knowledge,  he  often  feels  that  no 
progress  is  being  made.  But  if  he  comes 
nearer  to  his  confreres,  reads  the  scientific 
journals,  and  attends  the  medical  meet- 
ings, he  soon  realizes  that  general  medi- 
cine is  moving  steadily  on. 

In  a survey  of  the  progress  of  medicine, 
we  find  that  both  diagnosis  and  therap- 
eutics show  spectacular  achievements. 
Truly,  the  physician  of  our  forefathers 
would  be  bewildered  were  he  returned  to 
practice  medicine  today.  Research  work- 
ers are  digging  out  so  many  facts  and 
making  so  many  discoveries  that  no  one 
can  possibly  keep  up  with  all  of  them.  So 
fast  is  the  pace  that  text  books  are  out  of 
date  by  the  time  they  are  published. 

Every  domain  of  medicine  would  have  a 
right  to  honorable  mention  in  a paper  giv- 
ing recent  progress.  The  fields  of  bio- 
chemistry and  endocrinology  show  the 
most  progress  in  recent  years.  As  Can- 
tarow  has  well  said : “The  past  decade  has 
witnessed  the  emergence  of  many  well-es- 
tablished facts  from  the  obscure  maze  of 
theoretical  speculation  which  formerly 
clouded  the  field  of  endocrinology.  Fol- 
lowing the  discovery  of  insulin,  constitut- 
ing one  of  the  greatest  therapeutic  achieve- 
ments of  all  time,  the  co-ordination  of  im- 
proved surgical  technic  with  improved 
physiological  and  biochemical  methods  has 
resulted  in  the  elevation  of  endocrinologie 
research  to  a degree  of  exactitude  from 

(* — Read  before  the  Fifty-ninth  Annual  Session 
of  the  Arkansas  Medical  Society,  held  in  Little 
Rock,  April  16,  17,  18,  1934.) 


which  it  was  previously  far  removed.  Al- 
though the  practical  applications  of  many 
recent  observations  are  not  immediately 
apparent,  certain  advances  in  our  know- 
ledge of  the  functions  of  the  glands  of  in- 
ternal secretion  are  of  such  outstanding 
importance  as  to  merit  careful  considera- 
tion by  every  clinician,  regardless  of  his 
field  of  special  interest.  Unquestionably, 
the  physiology  of  today  is  the  medicine  of 
tomorrow;  increasing  recognition  of  this 
fact  is  perhaps  responsible,  more  than  any 
other  single  factor,  for  the  remarkable 
advances  made  in  clinical  medicine  in  re- 
cent years.” 

The  discovery  of  insulin  in  1921  by 
Banting  and  Best  has  revolutionized  the 
treatment  of  diabetes.  Every  medical 
practitioner  should  be  familiar  with  its 
virtues.  In  spite  of  the  very  carefully 
controlled  manner  in  which  insulin  was 
first  manufactured  and  distributed,  its  re- 
ception by  the  medical  profession  has  not 
been  so  cordial  as  the  product  deserves. 
Many  physicians  are  afraid  of  insulin,  and 
they  put  this  fear  into  their  patients.  The 
truth  of  the  matter  is  that  insulin  is  not 
so  dangerous  as  the  morphine  which  these 
same  physicians  freely  give.  Insulin  is 
health-producing  in  all  diabetics  and  life- 
saving in  diabetic  coma.  The  principle  is 
to  give  it  early  and  in  adequate  doses.  In- 
sulin has  recently  been  used  in  non-dia- 
betics as  an  aid  to  weight  building.  It  is 
the  best  appetizer  we  have. 

A few  short  years  ago  a patient  with 
pernicious  anemia  was  doomed  to  a linger- 
ing death.  Influenced  by  the  experiments 
of  Whipple,  we  find  Minot  and  Murphy 
announcing  to  the  world  in  1926,  an  effec- 
tive treatment  for  this  dreaded  disease. 
The  treatment  was  to  give  a half-pound  of 
liver  daily  to  these  patients.  Liver  is  not 
noted  for  its  palatability  and  a steady  diet 
of  it  soon  becomes  obnoxious  to  many  pa- 
tients. Under  the  leadership  of  Castle 
and  others  liver  extract  was  manufac- 
tured, and  was  a great  step  forward.  Now 
the  active  liver  principle  can  be  secured 
in  almost  any  form  for  the  most  fastidi- 
ous patient:  powder,  capsule,  liquid,  and 
ampules  for  parenteral  injection.  Not  be- 
ing satisfied  with  this  success  we  find 
workers  in  the  University  of  Cincinnati 
and  in  the  Medical  Clinic  of  the  Cincin- 


July,  1934] 


ARKANSAS  MEDICAL  SOCIETY 


33 


nati  General  Hospital,  introducing  a prep- 
aration called  Addisin.  Addisin  is  derived 
from  the  normal  gastric  juices  of  man, 
swine,  dogs,  and  cattle.  It  is  probably 
identical  with  the  “intrinsic  factor”  of 
Castle.  This  substance,  without  an  “ex- 
trinsic factor,”  such  as  beef  or  Vitamin 
B2,  gives  a prompt  and  sustained  hema- 
poietic  response,  following  intramuscular 
injection,  in  a patient  with  pernicious 
anemia.  These  workers  (Morris,  Schiff, 
Foulger,  and  Felson)  state  the  following: 
“Remarkable  hemapoietic  responses  in 
pernicious  anemia  have  followed  the  use 
of  single  large  doses  of  Addisin  obtained 
from  swine.  The  injection  of  30  units  of 
esterified  concentrate  resulted  in  a prompt 
reticulocytosis  of  24  days  duration,  ac- 
companied by  a blood  crisis  during  the 
first  12  days.  In  the  course  of  115  days, 
without  further  treatment,  the  red  count 
rose  from  1.4  million  to  4.5  million  and 
the  hemoglobin  from  47  per  cent  to  93  per 
cent.”  It  is  safe  to  predict  that  in  the 
near  future  we  will  be  treating  our  per- 
nicious anemia  cases  with  Addisin.  The 
same  substance  was  used  successfully  by 
these  investigators  in  cases  of  erythremia, 
acholuric  jaundice,  and  even  in  agranu- 
locytic angina. 

As  to  other  types  of  anemia  such  as  the 
hypo-chromic  or  micro-cytic,  it  has  been 
found  that  iron  is  the  best  agent.  Iron 
must  be  given  in  much  larger  doses  than 
we  have  been  accustomed  to  give.  The 
best  forms  are  the  iron  and  ammonium  ci- 
trate and  ferrous  carbonate.  The  citrate 
should  be  given  in  doses  of  from  45  to  90 
grains  daily,  and  the  carbonate,  50  to  75 
grains  daily.  These  are  much  larger  doses 
than  were  formerly  given  and  do  not  be 
surprised  if  your  druggist  questions  your 
prescriptions  written  for  such  dosage. 

A paper  on  Recent  Progress  in  Medi- 
cine should  certainly  make  mention  of  the 
use  of  cortin,  an  extract  of  the  adrenal 
cortex,  in  the  asthenias,  particularly  Addi- 
son’s disease.  To  quote  Hartman:  “In 
order  to  better  understand  the  clinical  use 
of  Cortin,  let  us  recapitulate  the  changes 
which  occur  in  cortin  insufficiency:  first 
and  foremost,  the  asthenias  of  the  nervous 
system,  muscular  system,  and  circulation, 
no  one  of  which  is  very  clearly  set  apart 
from  the  others ; renal  insufficiency,  which 


may  be  due  in  part  at  least  to  changes  in 
the  kidney  itself;  gastro-intestinal  insta- 
bility, which  may  have  both  peripheral  and 
central  elements;  reduced  metabolism  and 
growth,  which  depends  upon  the  activity 
of  the  tissues  concerned  as  well  as  the 
general  body  conditions;  lowered  resist- 
ance to  toxins,  which  may  be  merely  an- 
other aspect  of  lowered  function  in  a num- 
ber of  tissues ; the  increased  pigmentation 
and  changes  in  the  skin;  and  the  reduced 
activity  of  the  sex  organs.  We  speak  of 
these  as  cortin  insufficiencies  because  this 
substance  is  able  to  correct  or  abolish 
them.  The  relationship  to  vitamin  C de- 
ficiency likewise  must  not  be  forgotten. 
At  the  present  time  the  most  reasonable 
hypothesis  seems  to  be  that  cortin  is  a 
general  tissue  hormone;  but,  if  for  no 
other  reason  than  the  importance  of  the 
tissue  involved,  cortin  seems  to  play  a 
paramount  role  in  the  function  of  the 
nervous  system.  With  an  understanding 
of  the  changes  that  take  place  in  the  va- 
rious stages  of  adrenal  insufficiency  and 
their  responses  to  treatment  with  cortin, 
one  has  a basis  for  its  clinical  use  in  Addi- 
son’s disease  or  any  other  cortin  deficien- 
cy.” 

Heretofore,  patients  suffering  from  Ad- 
dison’s disease  were  considered  hopeless 
but  reports  now  show  that  when  cortin 
is  used  there  is  a noticeable  improvement 
in  a few  hours  and  the  road  to  recovery  is 
reached  in  three  to  five  days.  The  aver- 
age dose  of  cortin  is  three  to  ten  cubic 
centimeters  daily,  given  subcutaneously. 
Unfortunately,  this  promising  preparation 
is  not  in  general  use  because  of  the  cost 
of  production. 

So  far,  the  main  reports  of  progress  in 
this  paper  have  been  in  the  field  of  the- 
rapeutics. But  preventive  medicine  has 
also  shown  consistent  gains.  A notable 
example  is  the  immunization  against  dipth- 
theria.  The  inoculation  of  susceptible  per- 
sons with  toxin  antitoxin  mixtures  has 
greatly  reduced  the  incidence  of  this  dis- 
ease. Later  toxoid  was  introduced.  This 
is  effective  in  two  injections  rather  than 
the  three  of  toxin  antitoxin.  Recently  a 
further  simplification  has  been  brought 
forward  in  toxoid,  alum  precipitated.  The 
dose  is  only  .5cc  and  one  injection  is  suf- 
ficient in  most  cases. 


34 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  2 


There  has  been  some  advance  made  in 
the  control  of  epidemics  of  measles  by  the 
use  of  convalescent  serum  injected  into 
susceptible  and  exposed  individuals.  It  is 
hoped  that  this  phase  of  preventive  medi- 
cine will  be  further  clarified  and  ampli- 
fied in  the  near  future. 

The  domain  of  diagnosis  has  been  ever 
progressive.  Old  methods  have  been 
worked  over,  new  ones  introduced  and  re- 
finements of  clinical  observations  have 
been  presented  at  every  turn.  One  new 
disease  has  been  discovered — tularemia. 
It  is  the  only  disease  in  which  all  phases 
of  the  discovery  were  made  by  American 
investigators. 

In  closing,  let  me  emphasize  that  only 
a few  of  the  many  mileposts  of  progress 
have  been  mentioned.  Many  more  could 
easily  be  put  on  the  honor  roll.  It  is  hoped 
that  a contemplation  of  these  few  progres- 
sive achievements  will  fill  us  with  pride 
and  inspiration  for  further  developments 
to  the  end  that  we  may  be  better  fitted  to 
serve  our  patients. 


Proceedings  of  Societies 


Physicians  from  the  Southeast  Kansas 
Medical  Society  were  guests  of  the  Sebas- 
tian County  Medical  Society  at  a dinner 
meeting  June  12th  and  presented  the  fol- 
lowing program: 

“B.  C.  G.  in  Active  Immunization  of 
Tuberculosis/’  J.  R.  Wells,  Ph.D.,  Kansas 
State  Teachers  College,  Pittsburgh ; “Prac- 
tical Obstetrical  Hobbies  of  a General 
Practitioner,”  James  A.  Butin,  Chanute 
and  “Syphilis  of  the  Cardiovascular  Sys- 
tem,” Howard  E.  Marchbanks,  Pittsburg. 

James  W.  Amis,  Secretary. 


The  Ouachita  County  Medical  Society 
met  in  dinner  session  at  Camden  for  the 
following  program  presented  by  physi- 
cians of  Little  Rock:  “Lymphogranuloma 
Inguinale,”  H.  F.  DeWolf;  “Pituiturin  in 
Obstetrics,”  E.  H.  White,  and  “Some  Phas- 
es of  Intravenous  Medication,”  D.  R.  Har- 
deman. 

S.  A.  Thompson,  Secretary. 


The  following  program  was  presented  at 
the  meeting  of  the  Madison  County  Med- 
ical Society  held  in  Huntsville,  June  5th: 
“The  Value  of  the  Roentgen-Ray  to  the 
General  Practitioner,”  W.  R.  Brooksher, 
Fort  Smith ; “Bedside  Diagnosis  of  the  Up- 
per Abdomen,”  S.  J.  Wolfermann,  Fort 
Smith;  and  “Policies  of  the  Veterans’  Ad- 
ministration,” Frank  N.  Gordon,  Fay- 
etteville. Dr.  Chas.  B.  Beeby  entertained 
the  members  and  visitors  at  luncheon  at 
the  conclusion  of  the  meeting. 


The  Tri-County  Clinical  Society  met  at 
Hope  on  May  31st.  After  dinner  at  the 
Barlow  Hotel  the  following  program  was 
heard : 

Angina  Pectoris — W.  S.  Kerlin,  Shreve- 
port. 

Dietary  Deficiencies  as  Related  to  Den- 
tal Diseases — F.  M.  Talbot,  Shreve- 
port. 

The  Treatment  of  the  Psychoneuroses, 
or  So-Called  Nervous  Breakdown — 
D.  L.  Kerlin,  Shreveport. 

This  society  will  meet  next  at  Prescott 
on  June  28th. 

C.  K.  Townsend,  Secy. 


The  Ninth  Councilor  District  Medical 
Society  met  at  Eureka  Springs,  June  5th, 
electing  the  following  officers : President, 
J.  I.  Thompson,  Yellville;  1st  Vice-presi- 
dent, D.  L.  Owens,  Harrison;  2nd  Vice- 
president,  D.  K.  McCurry,  Green  Forest; 
and  Secretary-Treasurer,  J.  H.  Fowler, 
Harrison.  The  Society  will  next  meet  at 
Harrison  December  4th.  The  following 
program  was  presented : 

“Surgery  of  the  Chest,”  W.  A.  Hudson, 
Detroit;  “Policies  of  the  Veterans’  Ad- 
ministration,” Frank  N.  Gordon,  Fayette- 
ville; “Roentgen-Ray  Studies  of  Tubercu- 
losis,” J.  D.  Riley,  State  Sanatorium ; “The 
Office  Treatment  of  Hemorrhoids,”  M.  C. 
John,  Stuttgart;  “Intestinal  Obstruction,” 
I.  F.  Jones,  Fort  Smith,  and  “The  Practi- 
tioner of  Medicine  in  This  Changing 
World,”  F.  0.  Mahony,  El  Dorado.  A ban- 
quet was  held  in  the  evening  with  W.  H. 
Mock,  Prairie  Grove,  and  Congressman 
C.  A.  Fuller  as  speakers. 


July,  1934] 


ARKANSAS  MEDICAL  SOCIETY 


35 


THE  JOURNAL 

OF  THE 

Arkansas  Medical  Society 


Owned  by  the  Arkansas  Medical  Society  and  Published 
under  direction  of  the  Council. 


DR.  W.  R.  BROOKSHER,  Editor 
610  First  National  Bank  Bldg.,  Fort  Smith,  Arkansas 


Published  Monthly.  Subscription  $3.00  per  year;  sin- 
gle copies,  25  cents. 

Entered  as  second-class  matter  June  21,  1906,  at  the 
postoffice  at  Little  Rock,  Arkansas,  under  the  Act  of 
Congress  of  March  3,  1879. 

Acceptance  for  mailing  at  special  rate  of  postage  pro- 
vided for  in  Section  1103,  Act  of  October  3,  1917,  au- 
thorized August  1,  1918. 

The  advertising  policy  of  this  Journal  is  governed  by 
the  rules  of  the  Council  on  Pharmacy  and  Chemistry  of 
the  American  Medical  Association. 

All  communications  of  this  Journal  must  be  made  to 
it  exclusively.  Communications  and  items  of  general 
interest  to  the  profession  are  invited  from  all  over  the 
State.  Notice  of  deaths,  removals  from  the  State, 
changes  of  location,  etc.,  are  requested. 


OFFICERS  OF  THE  ARKANSAS  MEDICAL  SOCIETY 


F.  O.  MAHONY,  President El  Dorado 

M.  E.  MoCASKlLL,  President-Elect  _ Little  Rock 
A.  M.  ELTON,  First  Vice-President  Newport 

S.  C.  FULMER,  Second  Vice-President  Little  Rock 

F.  D.  SMITH,  Third  Vice-President Blytheville 

R.  J.-  CALCOTE,  Treasurer  __  Little  Rock 

W.  R.  BROOKSHER,  Secretary  . . Fort  Smith 


COUNCILORS 

First  District — W.  M.  MAJORS  Paragould 

Second  District — S.  J.  ALLBRIGHT  Searcy 

Third  District — M.  C.  JOHN  . Stuttgart 

Fourth  District — C.  W.  DIXON  Gould 

Fifth  District — L.  L.  PURIFOY  El  Dorado 

Sixth  District — DON'  SMITH  Hope 

Seventh  District — GEO.  B.  FLETCHER  Hot  Springs 
Eighth  District — S.  B.  HINKLE  Little  Rock 

Ninth  District — D.  L.  OWENS  Harrison 

Tenth  District — S.  J.  WOLFERMANN  Fort  Smith 


THE  OUACHITA  COUNTY  PLAN 
R.  D.  Robins,  Camden 


During  recent  years  much  attention  has 
been  given  to  the  possibilities  of  the  prac- 
tice of  preventive  medicine  in  the  office 
of  the  family  physician.  Opinion  both 
within  and  without  the  profession  has  been 
unanimous  in  the  belief  that  this  should 
be  developed  as  extensively  as  possible. 

At  a meeting  of  the  Ouachita  County 
Medical  Society  May  3,  1934,  a resolution 
was  passed  which  gives  the  family  physi- 
cian a large  place  in  the  field  of  preven- 
tive medicine.  The  resolution  states  that 
it  is  apparent  that  it  is  impossible  to  give 
thorough  and  proper  examinations  of 
school  children  when  they  are  herded  in 
large  groups  as  they  have  been  in  the  past 
in  school  clinics.  It  is  also  realized  that 
a large  percentage  of  parents  are  able  and 
prefer  to  have  these  examinations  made 
by  their  family  physician,  where  they  may 
be  examined  individually  and  more  thor- 


oughly. It  is  also  realized  that  a large 
percentage  of  people  who  are  given  vari- 
ous immunizations  free  by  the  health  de- 
partments are  able  to  pay  for  this  service. 

The  resolution  provides  that  hereafter 
in  Ouachita  County  the  following  policy 
will  be  adopted  by  the  city  and  county 
health  departments:  (1)  All  school  and 
pre-school  children  are  to  be  supplied  with 
the  necessary  forms  and  sent  to  their  fam- 
ily physician  or  physician  of  choice  for 
physical  examination.  The  physician  will 
examine  the  child,  fill  the  form  and  charge 
those  who  are  able  to  pay,  for  this  ser- 
vice. Those  who  are  not  able  to  pay  will 
be  given  the  same  examination  as  others. 
(2)  All  individuals  who  apply  for  immuni- 
zations, such  as  typhoid,  diphtheria  and 
small-pox,  will  be  referred  to  their  family 
physician  or  physician  of  choice  who  will 
give  such  immunization,  make  the  neces- 
sary records  and  charge  those  who  are  able 
to  pay  for  this  service.  Those  who  are  not 
able  to  pay  will  be  given  the  immuniza- 
tions, but  the  vaccine,  virus  or  toxin-anti- 
toxin will  be  furnished  by  the  health  de- 
partment as  it  is  at  the  present  time. 

Conferences  with  the  State  Health  Of- 
ficer, the  city  and  county  health  depart- 
ments, the  PTA  organizations  and  the 
school  officials  have  been  held  and  all  of- 
ficials and  organizations  have  promised 
their  hearty  co-operation  in  carrying  out 
this  program  in  this  county. 

The  success  of  this  program  will  depend 
on  the  close  co-operation  of  the  health  de- 
partment, the  PTA  organizations  and  the 
physicians.  Much  work  will  be  required 
of  the  health  department  and  the  PTA  or- 
ganizations in  seeing  that  the  children 
come  in  to  the  physicians  for  their  exami- 
nations and  immunizations.  It  was  thought 
by  some  at  first  that  this  was  a measure 
designed  to  annihilate  the  county  health 
unit.  That  was  far  from  the  motive.  It 
gives  the  unit  a great  field  of  work  in  an 
educational  and  a visitational  way.  They 
will  have  as  much  or  more  work  to  do  than 
they  had  before.  It  gives  the  county  unit 
an  opportunity  to  demonstrate  to  the  pri- 
vate practitioner  that  its  activity  is  worth- 
while to  the  community  and  to  him.  It 
will  make  the  practitioner  feel  that  the  ac- 
tivities of  a county  health  unit  are  indis- 
pensable. 


36 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  2 


LEGISLATIVE  POLICIES 

Val  Parmley,  M.  D.,  F.  A.  C.  S. 

Chairman,  Legislative  Committee 

For  the  past  twenty  or  twenty-five  years 
it  has  become  more  and  more  evident  that 
to  insure  protection  to  ourselves  and  to 
the  public  generally  we  should  take  an  ac- 
tive and  sometimes  aggressive  stand  po- 
litically. Moreover  it  has  become  equally 
apparent  that  we  must  stand  together  as 
one  man  for  or  against  such  questions  af- 
fecting the  medical  profession  in  legisla- 
tive procedure.  With  the  rise  of  certain 
irregular  elements  in  the  practice  of  the 
healing  arts  it  even  became  necessary  to 
employ  political  tricks  to  obtain  and  ob- 
struct certain  legislation  affecting  the 
public  and  the  profession  as  well  as  to 
maintain  the  standards  for  the  practice 
of  medicine  and  medical  education.  It 
should  not  be  necessary  to  have  to  resort 
to  such  methods  as  are  often  employed  by 
other  groups  but  there  have  been  occasions 
when  it  was  necessary  to  fight  poison  with 
poison,  so  to  speak. 

For  the  past  twenty  years  we  have  re- 
lied mainly  upon  the  sense  of  honesty  and 
fairness  in  our  representatives  in  the  Leg- 
islature together  with  such  influence  as 
might  be  brought  to  bear  upon  those  rep- 
resentatives through  our  own  personal  re- 
lations with  them.  However,  we  have 
finally  learned  the  lesson  that  a politician 
after  all  is  a politician  and  the  only  lan- 
guage he  really  understands  is  that  in 
which  the  word  “votes”  plays  a most  prom- 
inent part.  “Power”  and  “pressure”  are 
two  other  words  that* he  readily  under- 
stands. It  is  one  thing  for  the  politician 
to.  promise  his  support  of  certain  meas- 
ures and  another  thing  for  him  to  give 
that  support  when  the  time  comes  for  him 
to  vote  upon  the  measure.  In  other  words 
he  will  promise  everything  and  give  noth- 
ing. In  fairness  to  the  full  membership 
of  our  General  Assembly  I am  glad  to  say 
that  this  type  of  politician  is  beginning 
to  drop  out  of  the  picture.  However,  a 
sizeable  number  remains. 

Therefore  it  develops  that  the  organi- 
zation offering  the  greatest  number  of 
votes  and  threatening  with  the  greatest 
amount  of  power  and  pressure  receives 


the  greatest  amount  of  political  advantage. 
Realizing  this  several  years  ago  the  Chair- 
man of  your  Legislative  Committee  under- 
took to  organize  the  regular  medical  pro- 
fession into  a closely  knit,  compact  unit  of 
power  in  order  that  we  might  obtain  with 
less  expense  and  less  effort  the  protection 
that  the  profession  and  the  public  right- 
fully deserve.  He  made  talks  to  the  sev- 
eral district  societies  as  well  as  a number 
of  county  units.  The  result  at  the  next 
meeting  of  the  General  Assembly  sur- 
prised even  the  members  of  your  com- 
mittee. The  co-operation  was  excellent 
but  not  all  it  should  have  been.  Still  it 
was  sufficient  to  convince  the  members  of 
the  General  Assembly  and  the  state  offi- 
cials that  we  meant  business. 

About  two  years  ago  it  occurred  to 
your  Chairman  that  even  greater  power 
could  be  ours  by  lining  up  with  us  other 
groups  closely  allied  to  our  profession; 
namely,  the  druggists,  the  dentists,  'the 
nurses  and  the  hospitals.  Influential 
members  of  these  groups  were  contacted 
and  the  preparations  reached  a climax 
this  spring.  Arrangements  were  made 
for  your  Chairman  to  speak  to  the  various 
state  conventions.  Upon  these  occasions 
the  plans  for  legislative  co-operation  were 
outlined  to  them  and  the  reaction  was 
even  more  than  could  be  hoped  for.  Con- 
sequently we  have  the  support  of  these 
organizations  and  each  of  them  has  ap- 
pointed a Committee  on  Legislation  to  co- 
operate unqualifiedly  with  your  commit- 
tee. The  Chairman  of  these  several  com- 
mittees will  meet  soon  with  their  several 
representatives  to  confer  upon  proposed 
legislation,  protective  methods  and  co-op- 
eration. The  Presidents  of  each  of  the 
organizations  mentioned  have  assured 
your  Chairman  that  he  may  call  upon 
them  for  any  assistance  that  may  be  re- 
quired. This,  gentlemen,  is  in  our  opin- 
ion a real  step  forward.  It  simply  spells 
progress  and  protection. 

Now  we,  the  members  of  your  commit- 
tee, call  upon  you  to  bend  every  effort  to 
co-operate  with  your  local  dentists,  drug- 
gists, nurses  and  hospital  authorities  in 
the  selection  of  your  representatives  to 
the  General  Assembly.  In  other  words, 
get  together  with  the  members  of  our  al- 
lied professions  and  select  a candidate 


July,  1934] 


ARKANSAS  MEDICAL  SOCIETY 


37 


whom  you  know  will  stand  ‘pat”  and  then 
elect  him!  It  may  be  necessary  in  pro- 
tection of  yourselves  to  forget  personal 
friendships  and  unfriendliness  as  well. 

This  may  seem  a rather  drastic  meas- 
ure and  may  seem  to  be  too  much  of  ag- 
gressiveness on  our  part,  but  after  all, 
can  we  be  too  aggressive  when  we  realize 
that  frequently  the  very  foundations  of 
the  practice  of  the  healing  arts  are  being 
threatened  with  destruction?  We  do  not 
want  to  use  what  power  we  may  have  to 
rule  the  state  nor  to  obtain  class  legisla- 
tion, but  we  do  want  to  protect  ourselves 
and  protect  the  public  against  the  dema- 
gogue who  would  elect  to  dictate  to  us  our 
methods  of  practice.  In  defense  of  this 
stand  let  me  ask  where  would  our  civiliza- 
tion be  today  if  the  medical  profession  had 
not  taken  an  active  and  aggressive  stand 
upon  smallpox  vaccination,  malarial  con- 
trol, public  hygiene,  standards  for  medical 
education  and  the  laws  governing  crimi- 
nal operations?  Those  are  only  a few 
things  that  have  been  governed  by  aggres- 
sive political  action  on  the  part  of  the 
medical  profession. 

Your  Chairman  feels  that  when  this 
combined  organized  effort  will  have  been 
put  in  operation  that  it  will  be  the  most 
powerful  group  in  the  state  which  unsel- 
fishly asks  nothing  for  itself  but  only  that 
which  is  good  for  the  people  of  this  com- 
monwealth. It  would  be  impossible  to 
command  the  individuals  belonging  to 
these  groups  to  use  their  combined  power 
for  personal  or  professional  selfish  rea- 
sons. 

Your  Committee  expects  every  bit  of 
help  you  can  give. 


A complimentary  copy  of  the  Bulletin 
of  the  American  Society  for  the  Control 
of  Cancer  has  been  offered  any  physician 
requesting  it  from  the  society  at  1250 
Sixth  Avenue,  New  York  City.  Each  is- 
sue of  the  Bulletin  contains  a number  of 
short  practical  articles  written  by  dis- 
tinguished authorities  in  the  field  of  can- 
cer therapy  and  cancer  research.  The 
subscription  price  is  $1.00  a year. 


Personal  and  News  Items 


The  May  Tri-State  Journal  contains  the 
following  articles:  “Agenesia  of  the  Ab- 
dominal Muscles  in  a New  Born  Infant — 
Report  of  a Case,”  Don  Smith,  Hope; 
“Acute  Intestinal  Obstruction,”  A.  S. 
Buchanan,  Prescott;  “Measles  and  its  Man- 
agement,” S.  J.  McGraw,  El  Dorado; 
“Mononucleosis,”  R.  B.  Robins,  Camden, 
and  “The  Goat  ?”,  J.  L.  Roberts,  Nashville. 

R.  B.  Robins,  Camden,  took  post-gradu- 
ate work  at  the  Universities  of  Indiana 
and  Michigan  during  May. 


S.  F.  Hoge,  Little  Rock,  addressed  the 
staff  and  visitors  at  Hines  Hospital,  Chi- 
cago, during  the  April  meeting  of  the 
American  College  of  Physicians  on  “Extra- 
Pulmonary  Therapeutic  Oxygen.” 

A.  C.  Shipp,  Little  Rock,  has  been  re- 
elected Director  of  the  National  Tubercu- 
losis Association. 


The  following  physicians  were  in  at- 
tendance at  the  Oklahoma  State  Medical 
Association  meeting,  held  in  Tulsa,  May 
21-23,  1934:  M.  E.  Foster  (fraternal  dele- 
gate from  the  Arkansas  Medical  Society), 
E.  C.  Moulton,  I.  F.  Jones,  D.  W.  Gold- 
stein and  W.  R.  Br.ooksher. 


J.  E.  McGuire,  Piggott,  is  taking  a six 
week’s  post-graduate  course  at  the  New 
York  Polyclinic. 

“The  Value  of  a Neutralization  Test  of 
Gastric  Acidity  in  Patients  with  Duodenal 
Ulcers  and  So-Called  Pylorospasm,”  by  Je- 
rome S.  Levy,  Little  Rock,  appears  in  the 
April,  1934,  issue  of  Annals  of  Internal 
Medicine. 


Paul  Mahoney  and  family  spent  a vaca- 
tion motoring  to  Southern  cities  during 
June. 


The  honorary  degree  of  Doctor  of  Laws 
was  conferred  upon  Dr.  E.  F.  Ellis,  Fay- 
etteville, by  the  University  of  Arkansas 
June  4th.  Dr.  Ellis  has  completed  fifty 
years  of  active  practice,  more  than  thirty 
of  which  have  been  spent  in  Fayetteville. 


38 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  2 


Joe  F.  Shuffield  was  installed  as  Presi- 
dent of  the  Little  Rock  Lions  Club  on 
June  27th. 


F.  Walter  Carruthers  attended  the  meet- 
ing of  American-British  Association  of 
Bone  and  Joint  Surgeons  at  Rochester, 
Minnesota,  during  May. 

Dr.  W.  E.  Hamil,  Pocahontas,  has  open- 
ed a four-bed  hospital  at  his  office. 

Drs.  Robert  Eubanks  and  R.  Q.  Patter- 
son accompanied  the  Little  Rock  Good 
Will  Tour  to  North  Arkansas  during  June. 

Val  Parmley  addressed  the  following 
organizations  on  legislative  policies:  Lon- 
oke-Prairie  and  Arkansas  County  Medical 
Societies  June  12th,  and  the  Arkansas 
Pharmaceutical  Association,  at  Texarkana 
June  13th. 

Fellowship  in  the  American  College  of 
Radiology  was  conferred  upon  D.  A. 
Rhinehart  at  the  convocation  of  the  col- 
lege in  Cleveland  June  13th. 

J.  H.  McCurry  of  Cash  entertained  the 
physicians  of  his  district  at  the  annual 
fish  fry  on  June  7th. 

The  following  Arkansas  physicians 
were  in  attendance  at  the  American  Med- 
ical Association  in  Cleveland,  June  11-14: 
Hoyt  Allen,  Paul  G.  Autry,  E.  L.  Beck,  W. 

R.  Brooksher,  G.  E.  Cannon,  H.  F.  De- 
Wolf,  D.  W.  Goldstein,  W.  B.  Grayson,  C. 

S.  Holt,  W.  H.  Horn,  F.  L.  Husband.  A.  C. 
Kirby,  L.  J.  Kosminsky,  W.  C.  Langston, 
M.  F.  Lautmann,  L.  A.  Purifoy,  D.  A. 
Rhinehart,  B.  L.  Robinson,  J.  S.  Wilson 
and  Frank  Vinsonhaler. 


W.  C.  Langston  and  Byron  L.  Robinson 
of  the  University  of  Arkansas  School  of 
Medicine  presented  a scientific  exhibit  at 
the  American  Medical  Association  meeting 
on  castration  atrophy  and  theelin. 


Obituary 


C.  E.  GOSNELL,  aged  64  years,  died  at 
his  home  in  Bingen,  May  28th  of  nephritis. 
He  is  survived  by  his  wife  and  one  son  in 
addition  to  two  brothers  and  four  sisters. 


DAVID  A.  HUTCHINSON,  aged  85,  a 
charter  and  honorary  member  of  Howard- 
Pike  County  Medical  Society,  died  at  his 
home  in  Nashville  May  27th.  He  was 
born  in  Dadenville,  Alabama,  and  received 
his  medical  training  at  Tulane  University 
and  the  College  of  Physicians  and  Sur- 
geons of  Baltimore.  He  had  practiced 
medicine  for  sixty  years,  fifty-six  of  which 
were  spent  in  Nashville.  He  served  as 
the  first  mayor  of  Nashville  on  the  town’s 
incorporation  in  1884.  He  is  survived  by 
his  wife  and  four  sons,  one  of  whom  is 
Dr.  W.  A.  Hutchinson  of  Texarkana. 


MILES  DAWSON  KELLY,  aged  54, 
died  at  his  home  in  Lonoke  June  11th.  He 
was  born  in  Macon,  Georgia,  and  began 
the  practice  of  medicine  at  Sheridan  in 
1902,  practicing  at  Carthage  and  Watten- 
saw  before  moving  to  Lonoke  in  1919. 
His  early  education  was  received  in  the 
schools  of  Prattsville  and  his  medical  edu- 
cation at  the  University  of  Arkansas.  He 
was  a member  of  the  Chi  Zeta  Chi  medi- 
cal fraternity.  He  was  married  to  Susie 
Mary  Hodges,  February  21,  1904,  and  in 
addition  to  his  wife  is  survived  by  a 
daughter,  three  sons,  three  brothers  and 
a sister. 


A county  medical  society  secretary  is  a 
man  who  tries  all  year  to  get  a member 
to  pay  his  dues  and  then,  when  the  dues 
are  finally  paid  on  December  29th,  lets 
this  member  think  he  is  conferring  a 
favor. 


July,  1934] 


ARKANSAS  MEDICAL  SOCIETY 


39 


Auxiliary  Page 


MRS.  D.  W.  GOLDSTEIN,  Publicity  Secretary 
616  North  Greenwood  Avenue 
Fort  Smith,  Arkansas 


The  Woman’s  Medical  Auxiliary  to  the  Bowifr- 
Miller  County  Medical  Society  met  May  25th  for 
the  closing  meeting  of  the  year.  Hostesses  were 
Mesdames  George  Parson,  L.  P.  Goode,  W.  K. 
Reed,  J.  F.  Williams,  R.  R.  Kirkpatrick  and  N. 
B.  Daniels.  Mrs.  C.  E.  Kitchens  presided,  and 
announced  the  opening  number  on  the  program, 
as  a book  review,  “Medical  Women  of  America,” 
by  Meitts,  to  he  given  by  Dr.  Frances  Spinka.  A 
social  hour  was  enjoyed  and  a delicious  plate 
served  by  the  hostesses  to  the  members. 


The  Woman’s  Auxiliary  to  the  Independence 
County  Medical  Society  met  at  the  home  of  Mrs. 
R.  S.  Dorr  April  9th.  Officers  to  serve  for  the 
ensuing  year  were  elected,  as  follows : Mrs.  L.  T. 
Evans,  President;  Mrs.  Stark  Craig,  Vice-Presi- 
dent; Mrs.  C.  A.  Churchill,  Secretary;  Mrs.  J.  H. 
Kennerly,  Treasurer.  Delegates  elected  to  the 
state  meeting  were  Mrs.  Evans  and  Mrs.  Churchill 
with  Mrs.  F.  A.  Gray  and  Mrs.  G.  T.  Laman  of 
Cave  Springs,  alternates.  During  a social  hour 
which  concluded  the  meeting,  games  were  played 
and  refreshments  served  by  the  hostess. 


Meeting  for  the  last  social  and  business  ses- 
sion before  suspension  for  the  vacation  peroid, 
members  of  the  auxiliary  to  the  Sebastian  County 
Medical  Society  were  entertained  Monday,  June 
4th,  at  an  afternoon  party  at  the  home  of  Mrs. 
B.  B.  Bruce,  of  Alma.  At  the  business  meeting, 
the  recently  elected  officers  were  installed.  The 
official  family  is  composed  of  Mrs.  Eugene  Stev- 
enson, President;  Mrs.  A.  A.  Blair,  Treasurer, 
and  Mrs.  W.  F.  Rose,  Publicity  Chairman;  Mrs. 
I.  Fulton  Jones,  Secretary. 


Mrs.  B.  V.  Powell  and  Mrs.  Sam  Thompson 
were  hostesses  to  the  Auxiliary  of  the  Ouachita 
County  Medical  Society  on  Thursday  evening, 
May  3,  at  the  Powell  home  in  Camden.  Quanti- 
ties of  roses  of  varied  hues  were  used  as  decora- 
tions throughout  the  house  and  a delicious  three- 
course  dinner  was  served  by  the  hostesses.  Dur- 
ing the  business  session  the  following  new  officers 
were  installed:  Mrs.  B.  V.  Powell,  President; 
Mrs.  J.  S.  Rinehart,  President-elect;  Mrs.  R.  C. 
Kennerly,  Vice  President;  Mrs.  J.  B.  Jameson, 
Secretary-Treasurer. 


Book  Reviews 


The  Management  of  Fractures,  Dislocations,  and 
Sprains.  By  John  Albert  Key,  B.  S.,  M.  D.,  Clin- 
ical Professor  of  Orthopedic  Surgery,  Washington 
University  School  of  Medicine,  and  H.  Earle  Con- 
well,  M.  D.,  F.  A.  C.  S.,  Orthopedic  Surgeon  for 
the  Tennessee  Coal,  Iron  and  Railroad  Company, 
Birmingham.  Cloth.  Pp.  1,164  with  1,165  illus- 
trations. Price  $15.00.  St.  Louis:  C.  V.  Mosby 
Company,  1934. 

This  volume  is  commended  as  a practical  work- 
ing guide  to  all  practitioners  interested  in  the 
treatment  of  fractures.  Advances  in  this  field 
have  been  many  and  important  in  the  past  few 
years  and  are  not  discussed  in  standard  texts.  The 
authors  include  all  published  methods  of  practical 
value  and  give  a positive  expression  of  their  opin- 
ion from  a wide  experience  in  their  use.  Special 
attention  is  given  to  the  medico-legal  phases  of 
fractures,  a much-needed  contribution.  The  new- 
er knowledge  and  treatment  of  injuries  of  the 
spine,  skull,  pelvis  and  knee-joint  constitute  a 
valuable  section.  Well-printed,  amply  illustrated, 
and  authoritative  in  its  presentation,  this  work 
should  become  a standard  text. 


Surgical  Clinics  of  North  America.  (New  York 
Number — April,  1934.)  Volume  14,  Number  2. 
293  pages  with  72  illustrations.  Per  Clinic  year, 
published  bi-monthly,  paper  $12.00,  cloth  $16.00. 
Philadelphia:  W.  B.  Saunders  Co.,  1934. 

This  volume,  as  many  before  it,  reads  as  though 
one  had  the  cases  before  him  for  diagnosis  and 
treatment.  It  brings  us  bedside  diagnosis  and 
treatment  which  is  sometimes  lost  in  our  texts. 
We  find  ourselves  following  the  procedures  out- 
lined in  relation  to  the  ones  we  ax-e  using.  Keyes 
brings  up  the  question  as  to  the  best  operative 
procedure  for  prostates  and  leaves  one  with  the 
impression  that  the  supra-public  route  will  become 
the  operation  of  choice  for  the  general  surgeon. 
After  following  the  clinics  of  Cole,  Woolsey,  Hin- 
ton, and  Donovan  on  gastric  surgery  we  are  very 
apt  to  believe  Lahey  when  he  stated  that  what 
he  intended  to  do  was  to  try  and  map  out  a bet- 
ter medical  treatment. 

Farrar  sums  up  the  deaths  in  Woman’s  Hospital 
in  1932  and  analyzing  them  found  many  reasons 
to  advise  every  hospital  to  have  this  done. — I.  F.  J. 


Electrosurgery.  By  Howard  A.  Kelly,  M.  D., 
LL.D.,  F.  A.  C.  S.,  and  Grant  E.  Ward,  M.  D., 
F.  A.  C.  S.  Pp.  305,  with  382  illustrations.  Price 
$7.  Philadelphia  and  London : W.  B.  Saunders 
Company,  1932. 

This  volume  is  an  invaluable  guide  for  the  use 
of  the  newer  electrical  methods  in  surgery  Tis- 
sue changes  produced  by  the  cutting  currents 
are  defined  and  the  manner  of  their  production 
discussed.  It  is  a most  complete  manual,  chapters 
being  devoted  to  the  special  regions  of  the  body, 
while  operative  care  and  anesthesia  are  outlined. 


40 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  2 


Book  Reviews 


Mental  Hygiene  in  the  Community.  By  Clara 
Bassett,  Consultant  in  Psychiatric  Social  Work, 
Division  on  Community  Clinics,  The  National 
Committee  for  Mental  Hygiene,  Inc.,  The  Mac- 
Millan Company,  New  York,  386  pages.  Price 
$3.50. 

It  has  been  with  much  interest  that  I read 
“Mental  Hygiene  in  the  Community”  by  Clara 
Bassett  and  it  is  my  pleasure  to  give  it  hearty 
indorsement.  In  my  opinion,  this  book  should  be 
read  by  every  individual.  The  suggestions  are 
so  far-reaching  as  to  make  it  almost  impossible 
to  say  who  would  benefit  by  it  most.  It  will 
certainly  be  of  great  interest,  as  well  as  help,  to 
any  who  will  carefully  read  it. 

It  would  seem  that  parents  and  children  should 
be  interested  in  this  book.  To  bring  its  teachings 
and  practices  into  the  home  would  lead  to  a bet- 
ter understanding  in  that  home.  Make  for  more 
self  control  and  insure  more  individual  attention 
by  helping  the  parents  realize  the  necessity  of 
cultivating  the  art  of  living  and  the  knowledge 
of  home-making.  This  is  a subject  long  neglect- 
ed and  is,  in  a very  great  measure,  responsible 
for  the  crime  wave  now  sweeping  our  country,  as 
well  as  for  the  hundreds  and  thousands  now  oc- 
cupying our  hospitals  for  mental  diseases. 

So  I was  glad  indeed  to  know  of  this  effort 
on  the  part  of  Miss  Bassett  to  bring  results  in 
so  important  a field.  May  it  instill  in  the  hearts 
of  all  readers  a desire  for  the  realization  of  its 
teachings  in  their  state,  town  and  home. 

— P.  M. 


Medico-Military  Symposium.  The  Kansas  City 
Southwest  Clinical  Society,  Kansas  City,  Missouri. 
Various  authors.  Pp.  108.  Price  $1.00. 

This  volume  is  a compilation  in  abstract  form 
of  the  addresses  delivered  at  the  spring  confer- 
ence of  this  alert  medical  organization.  The  sub- 
ject matter  ranges  widely  along  medical  and  mil- 
itary lines,  reflecting  credit  to  the  director  for 
its  arrangement  in  program  form.  Being  in  ab- 
stract form,  the  volume  merely  intensifies  the 
regret  of  the  reviewer  that,  he  was  unavoidably 
in  absence  from  the  meeting. 


Treatment  of  the  Commoner  Diseases  Met  With 
By  the  General  Practitioner.  By  Lewellys  F. 
Barker,  M.  D.,  Professor  Emeritus  of  Medicine, 
Johns  Hopkins  University.  Pp.  319.  Price  $3.00. 
Philadelphia:  J.  B.  Lippincott  Company,  1934. 

This  book  is  based  upon  ten  lectures  delivered 
by  invitation  in  a post-graduate  course  in  the 
Academy  of  Medicine  of  Lima  and  Allen  Coun- 
ties, Ohio,  during  September,  1933.  The  author 
presents  a brief  resume  of  the  underlying  pa- 
thology and  pathological  physiology  of  the  dis- 
eases which  the  general  practitioner  is  daily 
called  upon  to  treat.  Upon  this  basis  he  then 
proceeds  to  present  practical  measures  for  use 
in  treatment  of  these  conditions.  The  general 
care  and  management  of  the  patient  is  fully  dis- 
cussed. Diseases  of  metabolism,  endocrinopathies 
and  vitamin  deficiencies  are  especially  well  cov- 
ered. This  book  should  be  of  particular  interest 
not  only  to  the  general  practitioner,  but  to  every 
physician. 

— R.  I.  M. 


Annual  Reprint  of  the  Reports  of  the  Council 
on  Pharmacy  and  Chemistry  of  the  American 
Medical  Association  for  1933.  Cloth.  Price,  post- 
paid $1.00.  Pp.  188.  Chicago:  American  Medi- 
cal Association. 

The  current  reports  deal  mainly  with  products 
which  the  Council  has  not  found  acceptable  for 
inclusion  in  New  and  Non-official  Remedies. 
Among  these  are  Niazo,  a pyridine  compound 
whose  value  as  a urinary  antiseptic  has  not  been 
substantiated;  Pyridium  and  Azophene,  similar 
agents;  and  a number  of  preparations  from  the 
Upjohn  Company  which  have  been  marketed  with 
unwarranted,  misleading  and  unscientific  claims. 
The  Council  warns  of  the  dangers  attending  thej 
use  of  Alpha  Dinitriphenol,  as  used  in  the  treat- 
ment of  obesity.  Newer  preparations  reported  are 
Dilaudid,  Fuadin  and  Hippuran.  There  is  a 
comprehensive  report  on  the  estrogenic  substances 
now  available  for  gynecologic  terapy.  The  Coun- 
cil’s second  report  on  the  intravenous  use  of 
barbiturates,  compiled  from  questionnaires,  re- 
affirms its  previous  decision  that  they  should  so 
be  employed  only  in  a limited  number  of  condi- 
tions in  which  their  administration  by  other  routes 
is  not  feasible. 


Granite  Mountain  Hospital 

Open  to  All  Reputable  Physicians  and  Surgeons 
S.  P.  JUNKIN,  M.  D.,  Medical  Director 
Telephone  Rural  9579-F2  Route  4,  Little  Rock,  Ark. 


J.  L.  Harris 

LITTLE  ROCK  ARTIFICIAL 


Roe  McCranie 

LIMB  CO. 


The  Old  Reliable  Firm  LIMBS  AND  BRACES 
521  1-2  Main  Street  Phone  5979 


Same  Location  Since  1911 

Little  Rock,  Ark. 


THE  JOURNAL 


of  the  ARKANSAS  MEDICAL  SOCIETY 

PUBLISHED  MONTHLY  UNDER  DIRECTION  OF  THE  COUNCIL 


|WE  DO  O'JR  PARTI 


Vol.  XXXI 


Fort  Smith,  Arkansas,  August,  1934 


No.  3 


SOME  SUGGESTIONS  IN  EXAMINA- 
TION OF  THE  CHEST* 


Oscar  W.  Bethea,  M.  D. 
Professor  of  Clinical  Medicine 
Tulane  University, 

New  Orleans. 


As  a result  of  years  of  effort  in  trying 
to  secure  the  greatest  amount  of  informa- 
tion from  physical  examinations,  I have 
found  some  procedures  of  sufficient  value 
to  be  worth  presenting  for  your  considera- 
tion. Most  of  these  have  been  previously 
published.  In  using  new  illustrations  and 
more  detailed  descriptions  my  aim  is  to 
stimulate  greater  interest,  further  study 
and  a more  general  use  of  a better  pro- 
cedure. 

In  preparing  for  a physical  examination 
of  the  chest  the  first  consideration  is  that 
of  obtaining  a favorable  environment. 

Quiet  is  essential.  In  the  home  or  hos- 
pital unnecessary  persons  should  be  ex- 
cluded and  those  remaining  instructed  as 
to  the  avoidance  of  movement  or  noise. 
Even  a loudly  ticking  clock  may  be  re- 
moved from  the  room.  Outside  noises  can 
be  lessened  by  temporarily  closing  the  win- 
dows and  doors.  In  my  private  office  I 
have  had  for  many  years  an  inside  sound- 
proof examining  room  that  has  proven  in- 
valuable for  good  work. 

The  temperature  of  the  examining 
room  should  be  comfortable.  If  too  cold, 
complete  relaxation  may  not  be  secured 
and  there  are  apt  to  be  muscle  tremors  and 
the  development  of  “goose  flesh”  resulting 
in  much  confusing  “static.”  If  too  warm 
the  patient  may  be  uncomfortable,  breathe 
abnormally  and  perspiration  interfere  ma- 
terially with  satisfactory  auscultation, 
especially  if  a diaphragm  type  of  stethe- 
scope  is  used.  I am  so  fortunate  as  to 

*Read  before  the  Fifty-ninth  Annual  Session 
of  the  Arkansas  Medical  Society,  held  in  Little 
Rock,  April  16-18,  1934. 


have  an  office  adequately  warmed  in  win- 
ter and  “air  conditioned”  in  summer.  The 
latter  convenience  further  enables  me  to 
shut  out  other  sounds  from  the  entire 
suite.  Men  should  be  stripped  to  the 
waist ; women  may  have  their  feelings  re- 
spected by  exposing  only  part  of  the  chest 
at  a time,  but  should  be  so  prepared  that 
this  can  be  readily  accomplished,  especially 
so  that  corresponding  areas  on  the  two 
sides  can  be  exposed  at  the  same  time. 
Women  of  today  seldom  cause  difficulty 
in  such  matters. 

When  there  is  hair  on  the  region  to  be 
particularly  studied,  as  the  region  of  the 
pulmonary  apices,  this  area  should  be 
carefully  shaved.  I have  found  it  of 
marked  advantage  to  sprinkle  the  skin 
with  talcum  and  to  lightly  go  over  this 
with  a cotton  sponge. 

The  position  of  the  patient  must  depend 
upon  his  ability  to  co-operate.  In  the  bed 
case  the  front  of  the  chest  may  be  exam- 
ined with  the  patient  in  dorsal  decubitus. 
A shift  of  position  may  be  necessary  only 
for  certain  special  investigations  relating 
to  the  heart.  For  examining  the  back  of 
the  thorax  the  patient  should  sit  up  if  pos- 
sible and  maintain  a comfortable  relaxed 
position  by  circling  his  flexed  knees  with 
his  arms.  Many  patients,  especially  chil- 
dren, may  comfortably  lie  in  ventral  de- 
cubitus. When  the  patient  is  in  such  a 
condition  that  he  can  only  be  turned  on  his 
side,  final  conclusions  should  not  be  drawn 
until  the  examination  has  been  made  with 
the  patient  lying  first  on  one  side  and  then 
on  the  other.  Most  of  us  have  been  led 
into  error  by  neglecting  this  precaution. 

In  office  work  I prefer  to  have  the  pa- 
tient standing.  For  examining  the  front 
of  the  chest  I have  him  placed  with  his 
back  resting  comfortably  against  a door 
(Fig.  1),  the  fingers  locked,  the  arms  re- 
laxed, the  shoulders  drooped  and  the  gaze 
directed  downward  at  an  angle  of  about 
45  degrees  and  fixed  on  a definite  object 


August,  1934]  ARKANSAS  MEDICAL  SOCIETY 


43 


The  results  are:  The  patient  is  comfort- 
able ; relaxation  is  complete ; the  hands  are 
occupied,  thus  preventing  scratching,  rub- 
bing or  other  disturbing  movements;  the 
head  is  fixed  in  position ; and  the  breath  is 
directed  downward.  In  examining  the 
back  of  the  thorax  I have  the  patient  stand 
out  from  the  wall,  the  hands  and  position 
generally  the  same  as  just  described  ex- 
cept that  the  body  is  inclined  further  for- 
ward by  directing  him  to  look  between  his 
feet.  (Fig  2.)  I have  measured  the  inter- 
scapular spaces  exposed  in  the  various  po- 
sitions commonly  used  for  such  work,  by 
marking  the  vertebral  borders  of  the 
scapulae  and  have  found  that  this  position 
meets  the  requirements  as  well  as  any 
other  if  not  better  (Fig.  3). 

Often  our  most  important  findings  re- 
sult from  a comparison  of  the  two  sides  of 
the  chest.  Therefore  to  obtain  the  most 
accurate  results  from  percussion,  it  is  nec- 
essary that  the  examiner  stand  with  his 
ears  equidistant  from  the  corresponding 
areas  studied,  that  is,  directly  behind  or  in 
front  of  the  patient  (Fig.  4).  If  the  ex- 
aminer has  only  one  good  ear  that  ear 
should  occupy  this  central  position. 

In  percussing  the  two  sides  for  com- 
parison, if  this  be  done  indiscriminately 
through  the  respiratory  cycles,  one  side 
may  be  struck  when  the  chest  is  empty  of 
tidal  air  and  the  other  when  it  is  full,  thus 
giving  a misleading  difference.  Percus- 


Fig.  1. — Position  for  examining  the  front  of 
the  chest. 

Fig.  2. — Position  for  examining  the  back  of 
the  chest. 

Fig.  3. — Showing  the  interscapular  space  ex- 
posed for  examination. 

Fig.  4. — Showing  position  of  examiner  for  per- 
cussion. 

Fig.  5. — A method  for  securing  co-operation 
of  the  patient  for  auscultation. 

Fig.  6. — Palpating  the  apical  impulse  of  the 
heart. 

Fig'.  7. — Finger  tip  palpation  of  the  apical  im- 
pulse of  the  heart. 

Fig.  8. — Spread  finger  palpation  of  the  chest. 

Fig.  9. — Palpation  to  determine  unilateral  im- 
pairment of  apical  expansion. 

Fig.  10. — Circumferential  mensuration  to  de- 
termine unilateral  impairment  (front). 

Fig.  11.- — Circumferential  mensuration  to  de- 
termine unilateral  impairment  (back). 

Fig.  12. — Measuring  the  upper  thorax  to  de- 
termine unilateral  impairment  (front). 

Fig.  13. — Measuring  the  upper  thorax  to  de- 
termine unilateral  impairment  (rear). 


sion  of  corresponding  areas  is  best  done 
while  the  patient  holds  his  breath  at  the 
end  of  exhalation  and  at  the  end  of  inhala- 
tion, this  to  be  repeated  until  the  whole 
chest  has  been  covered. 

For  each  auscultatory  combination — 
patient,  examiner,  stethoscope,  environ- 
ment, there  is  a rate  and  depth  of  respira- 
tory movement  that  will  give  the  best  re- 
sult. Sometimes  we  have  this  without  in- 
terference. More  often  we  do  not.  We 
may  either  do  our  best  with  what  the  pa- 
tient offers  or  try  to  secure  ideal  co-oper- 
ation. I wish  to  recommend  the  following 
scheme  as  having  met  the  requirements 
well: 

The  above  facts  are  briefly  explained  to 
the  patient.  The  chest  piece  of  the  stethe- 
scope  is  then  placed  over  an  apex;  the  ex- 
aminer’s free  hand  is  held  in  front  of  the 
patient  and  he  is  instructed  to  watch  it, 
inhaling  as  the  hand  is  raised ; exhaling  as 
it  is  lowered,  and  pausing  when  it  pauses. 
In  this  way  the  breathing  is  directed  until 
that  rate,  depth,  and  smoothness  is  ob- 
tained which  best  meets  the  requirements 
of  that  particular  case  (Fig  5).  The  pa- 
tient is  then  told  to  continue  to  breathe  in 
that  way  and  the  directing  hand  is  with- 
drawn. 

It  is  sometimes  difficult  to  locate  the 
apex  impulse  of  the  heart,  yet  its  deter- 
mination is  always  important.  I have  oft- 
en been  aided  by  palpating  the  intercostal 
spaces  with  the  ulnar  side  and  little  fin- 
ger of  the  right  hand.  (Fig  6) . The  hand 
is  placed  with  the  palm  up  as  it  may  then 
be  curved  better  to  fit  the  curving  inter- 
costal spaces.  The  greater  sensitiveness 
of  the  area  supplied  by  the  ulnar  nerve  to 
certain  impressions  has  been  demonstrat- 
ed, and  this  procedure  may  be  of  some  ad- 
ditional value  in  right-handed  individuals. 

Another  plan  is  to  place  the  sensitive 
tips  of  the  slightly  separated  fingers  in  the 
intercostal  spaces  (Fig.  7).  Either  of 
these  procedures  may  be  reinforced  by 
taking  advantage  of  forced  respiratory 
movements.  We  have  learned  in  using 
the  cardio-respiratory  test  of  Frost  that 
toward  the  end  or  just  after  a forceful 
respiratory  effort  the  systolic  pressure 
rises,  and  therefore  the  heart  beats  with 
more  force.  At  the  end  of  an  exhalation 
we  also  have  the  further  advantage  of  pul- 


44 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  3 


monary  retraction  better  exposing  the 
heart. 

For  palpating  the  thorax  to  locate  im- 
paired fremitus  the  custom  has  been  to 
apply  the  palmar  surface  of  the  whole 
hand  or  of  the  fingers,  or  the  back  of  the 
fingers  or  the  ulnar  side  of  the  hand.  What 
I wish  to  suggest  is  that  in  doing  this  we 
apply  only  the  palmar  surfaces  of  the 
slightly  separated  but  nearly  parallel  fin- 
gers (Fig  8).  The  palm  of  the  hand  should 
not  touch  the  skin  as  in  this  way  there  is 
less  tendency  for  vibration  to  be  trans- 
mitted from  one  finger  to  another  by  di- 
rect contact.  Beginning  well  up  in  the 
area  of  normal  vibration,  the  hand  is  low- 
ered a finger’s  breadth  at  a time  until  we 
are  conscious  of  the  fact  that  there  is  less 
vibration  under  the  lower  finger,  then  un- 
der the  two  lower  fingers,  and  finally  only 
the  upper  finger  is  in  the  area  of  unmodi- 
fied vibration.  A blue  pencil  mark  is  then 
made  between  the  two  upper  fingers.  The 
hand  is  so  placed  that  the  little  finger  is 
uppermost  as  it  is  supplied  by  the  ulnar 
nerve. 

In  palpation  to  determine  unilateral  im- 
pairment of  apical  expansion  the  custom 
has  been  to  stand  back  of  the  patient,  sad- 
dle the  hands  across  the  shoulders  with 
the  fingers  covering  the  upper  front  of 
corresponding  sides  of  the  chest;  or  to 
stand  in  front  of  the  patient  and  place  the 
palmar  surfaces  of  the  hands  and  fingers 
over  the  front  upper  part  of  the  chest  as 
the  patient  breathes  in  and  out.  My  sug- 
gestion is  that  we  stand  or  sit  directly 
back  of  the  patient,  placing  the  finger  tips 
high  up  on  the  axillary  region  or  each  side 
so  that  they  will  rest  in  corresponding  in- 
tercostal spaces  and  on  the  top  of  corre- 
sponding ribs.  The  hands  are  anchored 
in  position  by  the  palms  and  thumbs  grasp- 
ing the  scapula  groups  of  muscles  (Fig.  9) . 
As  the  patient  breathes  in  and  out  the  ex- 
amining hands  remain  in  position  on  the 
skin  while  the  ribs  in  rotating  and  lifting 
glide  under  the  finger  tips.  The  usual 
movement  is  a little  more  than  one  rib- 
width.  I believe  that  in  this  way  we  can 
more  accurately  determine  any  unilateral 
impairment  of  movement.  This  finding  is 
further  accentuated  by  the  fact  that  when 
one  side  is  impaired  the  other  side  tends 
to  take  on  a compensatory  hyperactivity. 


The  matter  of  mensuration  of  the  chest 
has  largely  fallen  into  disuse  due  to  the 
paucity  and  inaccuracy  of  the  information 
obtained.  The  custom  has  been  to  deter- 
mine merely  the  normal  circumference  of 
the  chest  and  the  degree  of  total  movement 
by  passing  a tape  around  and  taking  the 
readings  at  rest,  at  the  end  of  forced  in- 
halation and  at  the  end  of  forced  exhala- 
tion. This  gives  no  clue  as  to  the  most  im- 
portant data,  that  of  the  comparative  size 
and  comparative  movement  of  the  two 
sides.  I arranged  a special  device  consist- 
ing of  an  overcoat  button,  a carpet  tack 
and  two  pieces  of  common  tape,  reading 
out  in  each  direction  from  the  common  cen- 
ter. With  this  crude  equipment  I meas- 
ured the  chests  of  150  patients  who  had 
tuberculosis,  acute  pleurisy,  pleurisy  with 
serious  effusion;  localized  and  general 
empyema,  pulmonary  abscesses,  and  carci- 
noma. These  patients  were  all  studied  by 
means  of  X-ray,  physical  examinations, 
etc.,  and  the  information  obtained  by  this 
mensuration  proved  reliable  and  valuable. 
This  chest  tape  is  now  on  the  market  con- 
sisting of  a central  metal  button  to  which 
are  hinged  two  pieces  of  tape,  graduated 
both  in  inches  and  centimeters.  The  pa- 
tient is  first  prepared  by  making  blue 
pencil  marks  down  the  midline,  in  the 
front  and  back  of  the  chest.  The  central 
piece  is  held  on  the  line  in  front  by  an  as- 
sistant or  by  the  patient.  When  it  is  held 
by  the  patient,  the  index  fingers  of  both 
hands  are  used  so  as  to  make  the  distribu- 
tion of  the  chest  muscles  equal  on  both 
sides  (Fig.  10).  The  reading  is  taken 
where  the  two  tapes  cross  the  median  line 
in  the  back  (Fig.  11).  This  is  done  at  rest, 
at  the  end  of  a forced  inhalation  and  at 
the  end  of  a forced  exhalation.  As  these 
readings  are  taken  at  the  same  time,  dur- 
ing the  same  stages  of  the  same  respira- 
tory cycles,  the  findings  are  naturally  ac- 
curate. 

We  became  interested  in  the  results  of 
taking  these  measurements  across  the 
shoulders  and  the  two  pieces  of  tape  are 
hinged  on  the  common  center  so  that  this 
can  be  readily  done  (Fig.  12).  In  pre- 
paring a patient  for  this  a transverse  line 
is  made  across  the  lower  thorax  in  the 
back  and  the  readings  are  taken  where  the 
tapes  cross  this  line  (Fig  13),  at  rest,  at 
the  end  of  inhalation  and  at  the  end  of  ex- 


August,  1934]  ARKANSAS  MEDICAL  SOCIETY 


45 


halation.  I have  not  sufficient  data  on 
this  to  justify  any  definite  conclusions  but 
so  far  the  findings  have  been  interesting. 

As  might  be  expected  in  the  circumfer- 
ential measurements,  some  data  was  defi- 
nite. For  example, — in  pleurisy  with  either 
serous  or  purulent  effusion,  the  diseased 
side  was  larger  and  moved  less  on  respira- 
tion; in  fibroid  phthisis  the  diseased  side 
was  smaller  and  moved  less  on  respiration. 
In  the  shoulder  measurements  present 
findings  indicate  that  at  least  supplemen- 
tary information  of  value  may  be  obtained 
in  apical  involvement.  We  should  remem- 
ber that  one  of  the  first  reactions  to  dis- 
ease is  muscular  fixation  of  the  area.  We 
recognize  this  as  an  important  finding  in 
such  diseases  as  appendicitis  and  cholecyc- 
titis.  We  sometimes  overlook  the  fact  that 
the  same  condition  obtains  in  diseases  of 
the  thorax  and  that  here  also  there  will  be 
naturally  a limitation  of  the  respiratory 
movement  on  the  side  involved.  It  is  prob- 
able therefore  that  mensuration  has  a 
larger  field  of  usefulness  than  is  some- 
times imagined. 

In  pulmonary  conditions  requiring  sur- 
gical approach  such  as  pleurisy  with  effu- 
sion, the  custom  has  been  to  make  a phys- 
ical examination,  have  a film  made  and 
when  the  findings  indicate  that  aspiration 
or  other  operative  procedure  is  necessary, 
to  pick  out  the  site  for  puncture  or  incision 
by  a study  of  the  film  and  re-examination 
of  the  chest.  I tried  the  plan  of  making  a 


Fig.  14. — The  use  of  lead  markers  to  deter- 
mine the  best  site  for  aspiration. 


physical  examination  and,  when  it  seemed 
that  operative  interference  might  be  nec- 
essary, to  pick  out  what  seemed  to  be  the 
most  desirable  site,  fix  a small  coin  to  this 
area  with  adhesive  plaster  and  then  send 
the  patient  for  X-ray  study.  When  the 
film  was  studied  later  we  could  determine 
with  considerable  accuracy  if  the  proposed 
site  was  the  best,  if  not  we  could  measure 
the  correct  distance  and  direction  on  the 
film  then  make  the  same  measurements 
from  the  marker  which  had  been  left  on 
the  chest  of  the  patient.  The  results  were 
highly  satisfactory.  We  found,  however, 
that  small  coins  sometimes  did  not  show  up 
well  on  the  films  and  particularly  did  not 
lend  themselves  to  the  making  of  cuts  for 
publication.  This  especially  obtained  where 
the  details  were  not  clear  due  to  the  pres- 
ence of  marked  pathological  changes. 

With  the  assistance  of  Mr.  Charles  K. 
Goodman,  radiological  technician  at  the 
Baptist  Hospital  in  New  Orleans,  we  de- 
vised a distinctive  marker  that  could  not 
be  mistaken  for  anything  else.  (Fig.  14). 
This  is  now  on  the  market  at  a nominal 
cost.  When  a patient  has  already  been  as- 
pirated, it  is  our  custom  to  cover  each  old 
puncture  wound  with  a marker  before  hav- 
ing a film  made.  We  have  had  some  cases 
in  which  we  have  been  able  to  determine 
that  previous  punctures  for  aspiration, 
particularly  in  trying  to  remove  localized 
accumulations,  had  been  quite  far  away 
from  the  material  and  in  several  instances 
we  have  demonstrated  that  entrance  had 
been  made  well  below  the  diaphragm.  This 
plan  is  not  recommended  as  perfect,  but  as 
one  of  the  many  aids  that  at  times  prove 
of  such  value  as  to  justify  their  uniform 

employment. 



SUMMER  DIARRHEA  IN  BABIES 

Casec  (calcium  caseinate),  which  is  almost 
wholly  a combination  of  protein  and  calcium,  of- 
fers a quickly  effective  method  of  treating  all 
types  of  diarrhea,  both  in  bottle-fed  and  breast- 
fed infants.  For  the  former,  the  carbohydrate  is 
temporarily  omitted  from  the  24-hour  formula 
and  replaced  with  8 level  tablespoonfuls  of  Casec. 
Within  a day  or  two  the  diarrhea  will  usually  be 
arrested,  and  carbohydrate  in  the  form  of  Dextri- 
Maltose  may  safely  be  added  to  the  formula  and 
the  Casec  gradually  eliminated.  Three  to  six 
teaspoonfuls  of  a thin  paste  of  Casec  and  water, 
given  before  each  nursing,  is  well  indicated  for 
loose  stools  in  breast-fed  babies.  Please  send  for 
samples  to  Mead  Johnson  & Company,  Evansville, 
Indiana. 


[Vol.  XXXI,  No.  3 


THE  JOURNAL  OF  THE 


46 


PROGRESS  IN  OBSTETRICS* 


S.  B.  Hinkle,  M.  D.,  F.  A.  C.  S., 
Little  Rock. 


A careful  study  of  the  literature  would 
indicate  that  the  medical  profession  is  in 
bad  repute.  Notwithstanding  the  facts 
that  the  longevity  rate  has  been  almost 
doubled  within  the  past  half  century,  and 
that  in  thousands  of  cases  suffering  and 
disaster  have  been  prevented ; that  within 
the  recent  past,  the  mystery  of  such  dis- 
eases as  cholera,  yellow  fever,  typhoid, 
malaria,  and  dysentery  has  been  solved, 
and  their  incidence  tremendously  reduced ; 
that  certain  diseases  such  as  diabetes  and 
anemia  that  were  heretofore  progressively 
disabling  to  a fatal  issue,  are  being  treated 
so  that  their  victims  are  promised  years  of 
usefulness  and  comfort;  that  the  blind 
have  been  made  to  see,  the  deaf  to  hear, 
the  speechless  to  talk  and  the  heretofore 
hopeless  cripples  to  join  the  ranks  of  the 
useful  and  carry  on : we  are  reminded 
every  day  of  our  shortcomings  and  stand 
always  a target  for  literary  and  oratorical 
epithets.  Therefore,  I was  happy  indeed, 
to  accept  the  invitation  of  your  program 
committee  to  participate  in  this  year’s 
symposium  on  progress;  though,  to  tell 
the  plain  truth,  I doubted  that  I could 
show  much  of  real  advancement  in  ob- 
stetrics until  I began  studying  the  facts 
and  figures,  so  much  had  been  said  of  our 
faults  and  failings.  It  was  not  long,  how- 
ever, before  I was  convinced  that  I could 
come  to  you,  my  co-workers  in  Arkansas, 
with  record  evidence  of  your  progress. 

My  first  inquiry  was  of  the  Bureau  of 
iVtal  Statistics,  where  I had  my  first  thrill. 
I was  shown  that  the  maternal  death  rate 
for  Arkansas  is  being  materially  reduced ; 
and  while  I know  we  should,  and  believe 
we  will,  show  further  reductions,  I am 
happy  to  quote — in  1927  the  maternal 
death  rate  was  83  per  10,000  births;  in 
1932,  five  years  later,  that  rate  had  been 
reduced  to  66  per  10,000,  an  actual  gain  of 
a little  more  than  21  per  cent,  bringing 
with  it  a happy  reduction  in  the  number  of 
stillborn  babies;  and  this,  notwithstand- 
ing the  fact,  that  3,051  fewer  babies  were 

*Read  before  the  Fifty-ninth  Annual  Session 
of  the  Arkansas  Medical  Society,  held  in  Little 
Rock,  April  16,  17,  18,  1934. 


born  in  1932  than  in  1927.  This  reduction 
was  brought  about,  largely,  by  interfer- 
ences of  pregnancy,  formerly  considered 
criminal,  the  use  of  contraceptive  drugs, 
and  the  wearing  of  apparatus,  new  and 
necessarily  crude,  manufactured  and  prop- 
agandized by  some  of  our  American  rub- 
ber companies.  These  practices  can  do  no 
less  than  impair  health  and  increase  the 
hazards  of  child-bearing.  I hope  you  will 
pardon  this  gross  digression  from  my  sub- 
ject, but  I must  remind  you  that  prac- 
tically none  of  this  reduction  in  births  has 
been  brought  about  by  surgical  steriliza- 
tion of  the  diseased  and  the  unfit. 

How,  then,  has  this  improvement  been 
brought  about?  Not  by  any  particular  dis- 
covery or  invention,  but  by  better  obstet- 
rics; by  a more  complete  study  and  care- 
ful classification  of  the  maternity  case; 
by  a more  conservative  and  carefully  con- 
ducted labor ; by  immediate  and  intelligent 
attention  to  obstetrical  injuries  and  a care- 
fully supervised  recovery. 

Recent  years  have  shown  a marked  im- 
provement in  the  preparation  of  the  com- 
munity for  the  care  of  the  pathological 
case.  Twenty  years  ago  the  admission  of 
the  maternity  case  to  the  hospital  was  a 
major  emergency,  for  which,  there  was 
little  preparation  as  to  equipment,  nurs- 
ing supervision,  or  specially  trained  staff. 
At  present,  there  is  no  large  section  of  the 
state  not  provided  with  equipment  and 
staff  adequate  to  care  for  the  obstetrical 
emergency,  and  each  section  has,  at  least, 
one  man  who  gives  special  attention  to  the 
maternity  case  and  who  is  becoming  bet- 
ter and  better  trained. 

I feel  obliged  to  answer  some  of  the 
criticism  expressed  against  the  practice  of 
caring  for  the  maternity  case  in  the  gen- 
eral hospital,  which,  though  probably  made 
and  published  in  good  faith,  is  detrimental 
to  the  progress  of  obstetrics.  Vast  areas 
of  our  country,  though  well  supplied  with 
general  hospitals,  have  no  maternity  hos- 
pitals at  all,  and  indeed,  may  never  have. 
We  freely  admit  that  the  percentage  death 
rate  is  high,  probably  much  higher  than 
that  of  home  obstetrics,  but  a careful 
analysis  of  these  figures  will  adequately 
explain  it.  During  the  past  five  years, 
2,700  maternity  cases  were  admitted  to  the 
three  public  general  hospitals  of  Little 


August,  1934]  ARKANSAS  MEDICAL  SOCIETY 


47 


Rock,  and  of  these,  thirty-four  mothers 
died.  Twenty-nine  of  these  patients,  how- 
ever, were  admitted  as  emergencies.  Most 
of  these  had,  in  addition  to  their  pathology, 
been  exhausted  by  long  labor,  and  efforts 
to  deliver,  while  some  had  traveled  long 
distances  while  in  labor.  Nine  had  al- 
ready delivered  their  babies;  one  was  ad- 
mitted with  a macerated  fetus  in  utero, 
complicated  by  peritonitis;  one  with  car- 
dio-vascular  disease  and  apoplexy;  two 
were  admitted  for  ruptured  ectopic  preg- 
nancy, and  died  of  hemorrhage  and  shock ; 
one  with  a deformed  pelvis  was  admitted 
after  long  labor  and  died  within  a few  min- 
utes of  her  admission;  one,  after  three 
days  of  labor,  died  following  cesarean  sec- 
tion; one,  with  intestinal  obstruction,  was 
in  coma  when  admitted;  one  of  malaria; 
one  of  cancer  of  the  cervix ; nine  were  ad- 
mitted in  convulsions;  and  one  with  lobar 
pneumonia.  Of  the  five  patients,  who 
were  admitted  apparently  well,  three  died 
of  post-partum  hemorrhage ; one  of  abrup- 
tio  placenta ; and  one  died  following  cesar- 
ean section,  after  exhausting  labor. 

Medical  schools  are  giving  a great  deal 
more  attention  to  obstetrical  teaching;  a 
great  deal  more  of  actual  care  of  the  pa- 
tient is  demanded  of  the  student,  and  the 
universally  demanded  interneship  gives 
him  a much  better  training  in  delivery 
technique  and  post-partum  care.  Each 
year,  we  find  more  practitioners  making 
contact  with  men  competent  to  teach  ob- 
stetrics, and  each  year  the  teacher  is  more 
and  more  easily  available.  It  has  only 
been  a few  years  since  the  physician,  to 
have  reliable  post-graduate  work,  had  to 
make  long  and  expensive  trips  to  the  clin- 
ics of  the  North  and  East,  while  today,  ob- 
stetrical training  of  high  quality  is  avail- 
able in  all  large  cities  of  the  South.  Mem- 
phis holds  a clinical  congress  each  year, 
where  may  be  heard  the  best  in  the  world 
of  obstetrical  teachers.  New  Orleans, 
Dallas,  Houston,  and  other  nearby  cities, 
offer  like  opportunities.  Large  hospitals, 
such  as  St.  Louis  Maternity  and  New  Or- 
leans Charity,  offer  a wealth  of  clinical 
material  and  are  always  open  to  the  prac- 
titioner and  specialist.  Masters  in  the  art 
of  obstetrics,  such  as  the  Millers,  King, 
Sellers,  and  other  of  New  Orleans,  the 
Johnsons  of  Houston,  Willard  Cook  of 
Galveston,  Pride  of  Memphis,  and  many 


others,  in  nearby  Southern  cities,  thor- 
oughly competent  and  always  willing  to 
give  Arkansas  practitioners  the  value  of 
their  advanced  knowledge  and  skill  are  al- 
ways available  with  little  loss  of  time  and 
negligible  expense.  These  opportunities, 
and  many  others,  are  being  used  by  ever 
increasing  numbers.  These  are  some  of 
the  reasons  why  eclampsia  is  occurring 
less  frequently,  and  is  being  treated  much 
more  safely;  why  neonatal  blindness  is 
disappearing  from  our  state,  and  trau- 
matic idiocy  and  feeblemindness  are  be- 
coming less  frequent. 

While  claiming  a place  in  the  march 
line  of  progress  we  acknowledge  obliga- 
tion to  all  other  branches  of  medical  study 
and  practice.  The  improvement  in  labora- 
tory procedure  in  all  of  its  phases  is  sim- 
plifying the  work,  both  as  to  diagnosis 
and  treatment.  In  cases  of  infection  we 
would  naturally  be  hampered  in  diagnosis, 
prognosis,  and  treatment  without  the  blood 
counts.  The  recent  advancement  in  the 
classification  of  the  white  cell  gives  us, 
better  than  ever  before,  a check  on  the  se- 
verity of  the  infection,  and  our  patient’s 
capacity  to  combat  it.  Careful  cultural 
study  gives  us  accurate  information  re- 
garding blood  stream  infections  while 
treatment  may  be  effective;  blood  chem- 
ical studies  gives  us  valuable  differential 
information  as  to  the  existence  and  sever- 
ity of  uremia,  eclampsia,  and  diabetic 
coma;  typing  and  matching  of  the  blood 
for  transfusions;  preparation  and  titration 
of  intravenous  solutions ; put  in  our  hands 
therapeutic  measures  that  are  frequently 
life  saving. 

The  roentgenologist  is  contributing 
more  and  more  to  the  safety  of  child-bear- 
ing. He  frequently  gives  us  positive  in- 
formation of  vast  importance,  and  does  it 
quickly.  His  diagnosis  of  fetal  death,  ma- 
jor deformity,  multiple  pregnancy  and 
faulty  position  and  presentation  is  spec- 
tacularly accurate ; and  he  is  now  making 
us  take  seriously  his  promise  to  accurately 
measure  the  pelvis  and  the  baby’s  head. 

The  biological  diagnosis  of  early  preg- 
nancy exemplifies  the  axiom  so  frequently 
quoted  by  Brisbane,  “What  man  imagines, 
he  can  do.”  Far  beyond  the  memory  of 
any  of  us,  biologists  have  said  it  could  and 
would,  someday,  be  done.  The  Ascheim- 


48 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  3 


Zondeck  test  is  the  result,  and  with  its 
modifications,  is  used  by  obstetricians 
throughout  the  world. 

Progress  is  being  made  in  the  diagnosis, 
classification  and  treatment  of  sterility 
and  low  fertility.  Thousands  of  doctors 
are  carefully  studying  and  sympathetical- 
ly treating  this  condition,  and  reporting 
happy  results.  The  most  available  and 
easily  recitable  series  is  reported  by 
Loomis  of  California.  He  reports  732 
cases  listed,  539  completely  studied  and 
classified,  473  treated,  of  whom  208  be- 
came pregnant. 

The  use  of  analgesia  and  anesthesia  is 
not  particularly  new,  but  its  administra- 
tion is  being  simplified  and  refined,  and 
consequently  its  acceptance  is  becoming 
more  general.  Indeed,  at  the  present  time, 
few  women  are  denied  its  benefits  when 
attended  by  a competent  physician.  In 
hospital  practice,  nothing  has  been  more 
satisfactory  than  the  combination  of  mor- 
phine and  hyoscine  for  the  normally  pro- 
gressing labor,  with  the  addition  of  one  of 
the  more  positive  anesthetic  agents  for  its 
termination.  In  home  obstetrics,  where 
trained  assistance  cannot  be  had,  the  close 
attention  demanded  is  too  exhausting  to 
the  physician,  and  probably  should  not  be 
used.  In  these  cases  morphine  alone  or  in 
combination  with  small  doses  of  barbital 
is  giving  beautiful  results. 

Episiotomy,  in  the  carefully  selected 
case,  especially  in  primipara,  is  not  only 
doing  much  to  protect  the  soft  tissues  of 
the  mother,  but  is  reducing  birth  injuries 
in  the  child.  Restrictions  of  this  operation 
to  hospital  deliveries  would  seem  to  be 
quite  inconsistent.  It  is  a conservative 
measure.  If  the  doctor  has  been  interest- 
ed enough  to  provide  protection  for  his  pa- 
tient, and  is  prepared  to  treat  and  repair 
injuries,  he  should  be  able  to  forsee  and 
guard  against  them  with  the  same  relative 
promise  of  success. 

It  is  unfortunate  that  because  of  de- 
fective pelvis,  oversized  child,  and  a few 
other  reasons,  that  some  women  are  un- 
able to  terminate  their  labors.  I,  person- 
ally, am  happy  to  see  cesarean  section  tak- 
ing the  place  of  the  far  more  destructive 


procedure,  such  as  high  forceps,  podalic 
version,  and  pubiotomy.  The  technique 
has  been,  and  is  being  markedly  improved ; 
the  operation  being  now  more  of  a pelvic 
than  an  abdominal  one.  But  what  is  more 
important  is  the  advancement  noticed  in 
pre-partum  classification  and  mensura- 
tion, making  it  possible  for  the  operation 
to  be  done  while  the  patient  is  in  satisfac- 
tory condition,  before  exhausting  labor,  ef- 
forts to  deliver,  and  in  some  cases,  trans- 
portation over  a long  distance  to  a hos- 
pital, render  her  relatively  or  absolutely 
unfit. 

The  filthy  and  murderous  boaring  into 
and  through  the  delicate  structures  of  the 
mother,  causing  unbearable  torture  at  the 
time,  and  irreparable  damages  for  the  fu- 
ture, but  dignified  by  the  term  manual  di- 
lation and  assistance,  is  being  supplanted 
by  the  normal  effacement  and  dilation  of 
these  parts  by  the  means  provided  by  the 
All-Wise  Creator  of  Men.  All  the  assist- 
ance necessary,  or  wanted,  is  watchful 
waiting,  mild  narcotics  and  an  understand- 
ing heart.  This  is  being  provided  for  more 
and  more  people  as  the  years  go  by. 

For  the  puerperal  case;  bed  exercises,  a 
carefully  supervised  recovery,  a careful 
check  for  lacerations  of  the  cervix,  and 
undue  displacements  of  the  uterus,  and 
corrections  of  these  conditions,  are  reduc- 
ing obstetrical  morbidity. 

Incubation  of  the  immature  baby  is  a 
delicate  procedure,  but  can  be  done  in  any 
reasonably  well  ordered  home  provided 
with  reliable  electric  current  at  a negligi- 
ble cost.  It  can  be  started  by  any  intelli- 
gent nurse  and  carried  on  by  the  mother 
when  her  recovery  permits.  Special  diets 
for  the  undernourished  baby,  special  treat- 
ment for  the  probably  injured  baby,  de- 
veloped by  specialists  and  endorsed  by  the 
best  authority,  are  brought  to  you  repeat- 
edly. 

To  mention  all  of  the  new  instruments, 
new  equipment,  and  new  ideas,  advanced 
for  the  safety  and  comfort  of  child-bear- 
ing, would  require  too  much  of  your  time, 
and  after  all,  the  most  important  develop- 
ments are  in  the  minds  and  hearts  of  the 
men  and  women  interested  in  the  work. 


August,  1934]  ARKANSAS  MEDICAL  SOCIETY 


49 


THE  JOURNAL 

OF  THE 

Arkansas  Medical  Society 


Owned  by  the  Arkansas  Medical  Society  and  Published 
under  direction  of  the  Council. 


DR.  W.  R.  BROOKSHER,  Editor 
610  First  National  Bank  Bldg-.,  Fort  Smith,  Arkansas 


The  advertising  policy  of  this  Journal  is  governed  by 
the  rules  of  the  Council  on  Pharmacy  and  Chemistry  of 
the  American  Medical  Association. 

All  communications  to  this  Journal  must  be  made  to 
it  exclusively.  Communications  and  items  of  general 
interest  to  the  profession  are  invited  from  all  over  the 
State.  Notice  of  death®,  removals  from  the  State, 
changes  of  location,  etc.,  are  requested. 


COMMITTEES  : 

((Appointments  expire  in  the  year  indicated.) 

Scientific  Work — L.  L.  Purifoy,  Chairman  ; El  Do- 
rado (1935)  : R.  B.  Robins,  Camden,  (1936)  : W.  R. 
Brooksher,  Fort  Smith  (1937). 

Medical  Legislation — Val  Parmley,  Chairman,  Little 
Rock  (1937)  ; M.  L.  Norwood,  Lockesburg  (1937)  ; O. 
L.  Williamson,  Marianna  (1937)  ; H.  T.  Smith,  Mc- 
Gehee  (1936)  ; R.  L.  Smith,  Russellville  (1936)  ; A.  S. 
Buchanan,  Prescott  (1935)  ; H.  A.  Dishongh,  Little 
Rock  (1935). 

Health  and  Public  Instruction — W.  B.  Grayson, 
Chairman,  Little  Rock  (1937)  ; S.  W.  Douglas,  Eu- 
dora  (1937)  : B.  M.  Stevenson,  Crawfordsville  (1937)  ; 
H.  K.  Carrington,  Magnolia  (1936)  ; H.  A.  Stroud 
Jonesboro  (1936)  ; J.  H.  Fowler,  Harrison  (1935).  E. 
J.  Munn,  El  Dorado  (1935). 

Medical  Education  and  Hospitals — Joe  F.  Shuffield, 
Chairman,  Little  Rock  (1937)  ; David  Levine,  El  Do- 
rado (1936)  ; J.  B.  Futrell,  Rector  (1935). 

Public  Relations — D.  A.  Rhinehart,  Chairman,  Lit- 
tle Rock  (1937)  ; E.  E.  Barlow,  Dermott  (1936)  ; M. 
E.  McCaskill,  Little  Rock  (1935). 

Medical  Economics — I.  F.  Jones,  Chairman,  Fort 
Smith  ( 1937)  : R.  B.  Robins,  Camden  1937)  ; J.  E. 
Neighbors,  Stuttgart  (1936)  ; D.  E.  White,  El  Dorado 
(1936):  Roy  Millard.  Dardanelle  (1935);  A.  C.  Shipp, 
Little  Rock  (1935)  ; R.  M.  Sloan,  Jonesboro  (1935). 

Scientific  Exhibit — F.  H.  Krock,  Chairman,  Fort 
Smith  (1935):  H.  King  Wade,  Hot  Springs  National 
Park  (1936)  ; W.  E.  Gray,  Jr„  Little  Rock  (1937). 

Arrangements — (Host  Society  1935  meeting) — D.  W. 
Goldstein,  Chairman.  C.  S.  Holt,  J.  A.  Foltz,  H.  Moul- 
ton, M.  E.  Foster,  W.  G.  Eberle. 

Necrology — W.  H.  Mock,  Chairman,  Prairie  Grove 
(1935)  : J.  M.  Lemons,  Pine  Bluff  (1936)  ; H.  Moul- 
ton. Fort  Smith  (1937). 

Auxiliary — L.  J.  Kosminsky,  Chairman,  Texarkana 
(1935):  H.  T.  Wootton,  Hot  Springs  National  Park 
(1936)  ; C.  S.  Holt,  Fort  Smith  (1937). 

Cancer  Control — D.  W.  Goldstein,  Chairman,  Fort 
Smith  (1937);  R.  L.  Saxon,  Little  Rock  (1936);  L. 
A.  Purifoy,  El  Dorado  (1935). 


REPORT  OF  DELEGATES  TO  THE 
AMERICAN  MEDICAL  ASSOCIATION 


The  85th  annual  session  of  the  Ameri- 
can Medical  Association  held  in  Cleveland, 
June  11-1 5th,  demonstrated  anew  the  lead- 
ership of  organized  medicine  in  its  efforts 
to  solve  the  many  and  complex  problems 
affecting  medical  practice  and  the  eco- 
nomic status  of  the  individual  physician. 
Most  important  among  the  resolutions 
adopted  by  the  House  of  Delegates  was 
that  one  outlining  policies  for  the  guid- 
ance of  the  profession  when  new  forms  of 
medical  practice  are  under  consideration. 


For  the  first  time  a positive  statement  is 
available  on  just  what  qualifications  shall 
determine  the  acceptability  of  any  eco- 
nomic variation  in  the  practice  of  medi- 
cine. This  is  a clear  statement  of  princi- 
ples, ten  in  number,  prepared  by  the  Bu- 
reau of  Medical  Economics  and  approved 
by  a special  reference  committee  and  the 
Judicial  Council: 

1.  All  features  of  medical  service  in  any  meth- 
od of  medical  practice  should  be  under  the  control 
of  the  medical  profession.  No  other  body  or  in- 
dividual is  legally  or  educationally  equipped  to 
exercise  such  control. 

2.  No  third  party  must  be  permitted  to  come 
between  the  patient  and  his  physician  in  any 
medical  relation.  All  responsibility  for  the  char- 
acter of  medical  service  must  be  borne  by  the 
profession. 

3.  Patients  must  have  absolute  freedom  to 
choose  a legally  qualified  doctor  of  medicine  who 
will  serve  them  from  among  all  those  qualified 
to  practice  and  who  are  willing  to  give  services. 

4.  The  method  of  giving  the  service  must  re- 
tain a permanent,  confidential  relation  between 
the  patient  and  a “family  physician.”  This  rela- 
tion must  be  the  fundamental  and  dominating 
feature  of  any  system. 

5.  All  medical  phases  of  all  institutions  in- 
volved in  the  medical  service  should  be  under 
professional  control,  it  being  understood  that  hos- 
pital service  and  medical  service  should  be  con- 
sidered separately.  These  institutions  are  but  ex- 
pansions of  the  equipment  of  the  physician.  He 
is  the  only  one  whom  the  laws  of  all  nations 
recognize  as  competent  to  use  them  in  the  de- 
livery of  service.  The  medical  profession  alone 
can  determine  the  adequacy  and  character  of 
such  institutions.  Their  value  depends  on  their 
operation  according  to  medical  standards. 

6.  However  the  cost  of  medical  service  may  be 
distributed,  the  immediate  cost  should  be  borne 
by  the  patient  able  to  pay  at  the  time  the  service 
is  rendered. 

7.  Medical  service  must  have  no  connection 
with  any  cash  benefits. 

8.  Any  form  of  medical  service  should  in- 
clude within  its  scope  all  qualified  physicians  of 
the  locality  covered  by  its  operation  who  wish  to 
give  service  under  the  conditions  established. 

9.  Systems  for  the  relief  of  low  income  class- 
es should  be  limited  strictly  to  those  below  the 
“comfort  level”  standard  of  income. 

10.  There  should  be  no  restrictions  on  treat- 
ment or  prescribing  not  formulated  and  enforced 
by  the  organized  medical  profession. 

Other  important  actions  of  the  House 
of  Delegates  were: 

1.  Declaring  “essentially  unfair”  the  securing 
of  free  hospitalization  and  medical  attention  in 
government  institutions  by  those  not  legally  en- 
titled to  such  service  (congressmen,  judges,  sen- 
ators, etc.). 


50 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  3 


2.  The  action  of  the  State  of  Louisiana  in 
planning  to  finance  additions  to  its  Charity  Hos- 
pitals by  revenue  obtained  from  private  patients 
treated  therein  was  declared  “exploitation  of  the 
medical  profession.” 

3.  Hospital  staffs  of  all  hospitals  approved 
for  interne  training  shall  be  composed  exclusively 
of  members  of  the  American  Medical  Associa- 
tion. 

4.  Urged  state  medical  societies  to  appoint 
special  committees  to  confer  with  similar  com- 
mittees from  the  legal  profession  to  eliminate 
the  evils  in  the  field  of  expert  testimony. 

5.  Requested  that  state  and  county  relief  ad- 
ministrative bodies  include  physician  members. 

6.  Recommended  that  the  use  of  the  roent- 
gen-ray for  both  diagnostic  and  therapeutic  pur- 
poses be  under  the  direct  control  and  supervision 
of  licensed  physicians. 

7.  Asked  that  proper  steps  be  taken  to  prevent 
the  exploitation  of  roentgenologists  by  hospitals 
making  a practice  of  selling  the  services  of  such 
physicians  to  the  public  at  a profit. 

8.  Condemned  the  exploitation  of  dangerous 
and  valueless  drugs  direct  to  the  lay  public  in 
radio  advertising.  Asked  that  a bureau  be  es- 
tablished to  counsel  with  broadcasting  stations  on 
the  nature  of  drug  advertising  which  might  be 
under  consideration. 

9.  Asked  for  an  investigation  of  medical  pat- 
ents and  the  funds  received  from  such  sources. 

10.  Adopted  three  amendments  to  the  Princi- 
ples of  Medical  Ethics: 

A.  Clarifying  that  section  referring  to  con- 
tract practice. 

B.  Warning  clinics  and  similar  institutions 
that  group  practice  is  governed  by  the  same  prin- 
ciples as  is  the  individual  physician. 

C.  Declaring  unethical  the  exploitation  of  phy- 
sician’s services  by  lay  groups  or  institutions 
when  such  institutions  derive  direct  profit  from 
the  sale  of  these  professional  services. 

11.  Reapportioned  representation  in  the  House 
of  Delegates.  Arkansas  retains  two  delegates. 

12.  Invited  the  Canadian  Medical  Association 
to  meet  in  joint  scientific  session  with  the  Ameri- 
can Medical  Association  in  1935. 

13.  Asked  that  special  committees  be  appoint- 
ed to  confer  with  labor  and  industry  in  order  that 
the  position  of  organized  medicine  with  reference 
to  health  insurance  might  be  clearly  determined. 

Over  6,000  physicians  were  in  attend- 
ance and  the  scientific  exhibits  and  pro- 
grams were  exceptional  in  quality  and 
educational  value.  The  local  committees 
deserve  praise  for  the  smooth  operation  of 
the  convention.  James  C.  McLester,  Pro- 
fessor of  Medicine  in  the  University  of 
Alabama  School  of  Medicine,  Birmingham, 
was  elected  President-Elect.  The  1935  ses- 
sion will  be  held  in  Atlantic  City. 

L.  J.  Kosminsky. 
W.  R.  Brooksher. 


Editorial  Comment 


A new  stock-selling  scheme  is  being  pro- 
moted in  the  state  with  physicians  offered 
the  “ground  floor”  opportunity.  This  plan 
apparently  provides  for  a monthly  assess- 
ment plan  of  health  insurance,  the  policy- 
holder to  call  only  the  physician  stock- 
holder in  case  of  illness.  Just  what  re- 
muneration the  physician  will  receive,  and 
when  it  will  be  received,  is  not  quite  clear. 
Obviously,  promotion  and  administration 
expenses  will  be  deducted  from  these  as- 
sessments. Possibly  the  balance  will  be 
allotted  the  physicians.  Before  investing 
— investigate ! 


The  recent  meeting  of  the  American 
Medical  Association  demonstrated  a pleas- 
ing unity  of  the  medical  nrofessi''vn  H the 
fight  for  preservation  of  its  rights,  for  a 
high  quality  of  medical  service  and  for 
the  continuance  of  the  practice  of  scien- 
tific medicine  in  accordance  with  ethical 
standards.  The  inference  was  clear  that 
the  medical  profession  of  America  heeds 
but  one  spokesman — The  American  Medi- 
cal Association.  No  other  organization 
may  rightly  claim  to  speak  for  the  medi- 
cal profession,  no  other  organization  may 
lay  claim  to  representing  approximately 
three-fourths  of  the  actively  practicing 
physicians  of  this  country.  The  condem- 
nation of  a special  society  whose  action  on 
prepayment  insurance  plans  had  been  re- 
leased to  the  press  immediately  prior  to 
the  convening  of  the  first  meeting  of  the 
House  of  Delegates  was  strong  in  tone,  yet 
none  too  strong  when  the  resentment 
shown  by  the  delegates  is  considered.  The 
explanation  of  this  society,  while  awaited 
with  interest,  will  be  academic  in  its  ap- 
peal. The  action  of  the  House  of  Dele- 
gates has  served  well  to  remind  this,  as 
well  as  other  special  organizations  of  phy- 
sicians, that  they  too  are  subject  to  the 
policies  made  effective  by  county,  state 
and  the  national  organizations. 


A motion  picture,  “The  Physiology  of 
Fertilization  in  the  Human  Female,”  has 
recently  been  shown  to  medical  societies 
in  Arkansas.  First  exhibited  at  the  re- 
cent meeting  of  the  American  Medical  As- 
sociation in  Cleveland,  this  film  provides 


August,  1934]  ARKANSAS  MEDICAL  SOCIETY 


51 


the  practitioner  with  a theory  of  sound 
medical  principles  which  may  well  be  used 
in  his  advice  to  couples  on  marital  rela- 
tions, thereby  avoiding  the  mechanical  and 
chemical  contraceptives,  many  of  which 
are  actually  harmful  besides  being  of 
doubtful  value.  The  efficiency  of  the 
principles  set  forth  has  been  shown  to  be 
equal  to  if  not  greater  than  that  of  other 
methods.  Provision  is  made  for  the  phy- 
sician to  enlarge  his  field  of  service  to  the 
public  in  a perfectly  ethical  manner  on  a 
scientific  subject  that  until  recently  was 
entirely  in  the  realm  of  folklore  medicine. 
This  film  may  be  booked  upon  application 
to  Mead  Johnson  and  Company,  Evans- 
ville, Indiana,  by  any  society  desiring  to 
present  it. 


Of  interest  in  connection  with  the 
Dionne  quintuplets  are  the  researches  of 
R.  L.  DeBuys,  of  New  Orleans,  into  the 
history  of  multiple  pregnancies.  He  found 
that  while  quintuplets  were  born  but  once 
in  41,600,000  cases,  quadruplets  were  born 
once  in  747,000  instances,  triplets  once  in 
7,103  cases,  while  twins  appear  once  in 
every  87  cases.  He  also  ascertained  that 
the  Dionne  babies  were  the  31st  authen- 
tically known  set  of  quintuplets.  Mathe- 
matically in  contrast  with  the  figures  of 
DeBuys  are  those  of  W.  W.  Gruelich  of 
the  University  of  Colorado,  who  computes 
the  chances  for  twins  as  one  in  87 ; of 
triplets,  one  in  7,569;  of  quadruplets,  one 
in  658,503,  and  of  quintuplets,  one  in  57,- 
289,761.  And  that’s  that. 


Members  who  have  not  done  so  are 
urged  to  read  “ Standard  Treatment  Pro- 
cedure in  Early  Syphilis”  by  John  R. 
Stokes  in  the  April  21st  issue  of  The  Jour- 
nal of  the  American  Medical  Association. 
This  is  an  authorative  article,  based  upon 
a world-wide  investigation,  of  interest  to 
every  practitioner.  The  author  states : “The 
modern  system  for  the  treatment  of  early 
syphilis  must  be  continued ; it  must  call  for 
not  less  than  twenty,  and,  unless  special 
resistiveness  is  encountered,  hardly  more 
than  thirty  injections  of  the  arsphena- 
mine;  and  in  accordance  with  the  princi- 
ples generally  recognized  in  the  treatment 
of  the  disease,  the  system  should  call  for 
continued  treatment  with  heavy  metal  for 
one  year  after  all  symptoms  and  signs  of 


the  disease  have  disappeared.  In  order  to 
determine  this  end-point,  blood  tests  should 
be  made  at  the  beginning  and  end  of  each 
arsphenamine  course  and  the  patient 
should  be  warned  of  the  lack  of  signifi- 
cance of  the  negative  report  from  the 
standpoint  of  the  schedule.” 


Obituary 


DR.  OTHELLO  MORENO  BOUR- 
LAND,  aged  75  years,  died  at  Van  Buren, 
June  28th,  after  a critical  illness  of  but  a 
few  days  although  his  health  had  been  im- 
paired since  1929  to  such  an  extent  that 
he  had  ceased  active  practice.  Dr.  Bour- 
land  was  born  at  Lone  Elm,  Crawford 
County,  in  1859  and  had  practiced  medi- 
cine for  51  years.  He  graduated  from  the 
Saint  Louis  Medical  College  before  his  21st 
birthday  and  did  post-graduate  work  at 
Vanderbilt  University.  He  was  an  hon- 
orary member  of  the  Crawford  County 
and  the  Arkansas  Medical  Society.  Sur- 
viving him  are  his  wife,  two  daughters 
and  one  son. 


BENJAMIN  F.  TARVER,  Star  City, 
aged  70,  died  at  his  home  June  20th,  fol- 
lowing a cerebral  hemorrhage.  Dr.  Tar- 
ver was  born  at  Walnut  Grove,  Mississip- 
pi, in  1864,  and  received  his  degree  at  the 
University  of  Louisville  School  of  Medi- 
cine in  1891.  He  began  practice  at  Star 
City  in  1892  and  has  since  made  that  his 
home.  Dr.  Tarver  was  one  of  the  oldest 
residents  of  Lincoln  County  and  one  of 
the  few  surviving  members  of  Bob  McCul- 
lough Camp,  U.  C.  V.  He  is  survived  by 
his  wife,  a sister,  and  seven  sons,  one  of 
whom  is  Dr.  Vernon  Tarver,  of  Star  City. 

JAMES  VANCE  FERGUSON,  El  Do- 
rado, aged  34,  died  at  Rochester,  Minne- 
sota, July  8th.  Dr.  Ferguson’s  prelim- 
inary education  was  obtained  in  the 
schools  at  Marshall,  Arkansas,  and  his 
medical  degree  from  Tulane  University  in 
1923.  Following  interneship  and  one  year’s 
work  at  the  Mayo  Clinic  he  became  asso- 
ciated with  Dr.  J.  B.  Wharton.  He  is  sur- 
vived by  his  parents,  three  brothers  and 
six  sisters. 


52 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  3 


Proceedings  of  Societies 


The  Tri-County  Medical  Society  met  in 
dinner  session  at  Prescott,  June  28th,  for 
the  following  program : 

“Infections  of  the  Hand”  (lantern  demon- 
tration) — Geo.  V.  Lewis,  Little  Rock 
“Treatment  of  Acute  Complications  of 
Gonorrhea”- — G.  W.  Reagan,  Little  Rock 
“Care  During  Pregnancy” — C.  D.  Rodgers, 
Little  Rock. 

The  Society  will  next  meet  at  Arkadel- 
phia  July  26th. 

C.  K.  Townsend,  Secy. 


W.  G.  Eberle,  Fort  Smith,  addressed  the 
Crawford  County  Medical  Society  June 
26th  on  “Fertilization  of  the  Human  Fe- 
male.” The  Mead  Johnson  motion  picture 
“The  Physiology  of  Fertilization  in  the 
Human  Female”  was  exhibited. 


Saline  County  Medical  Society  sponsored 
a tonsil  clinic  at  the  Bauxite  Hospital  on 
July  2nd  and  a tuberculosis  diagnostic 
clinic  on  July  25th. 


Washington  and  Benton  County  Medi- 
cal Societies  held  their  annual  picnic  ses- 
sion at  Cave  Springs,  July  12th.  Speak- 
ers were:  S.  J.  Wolferman,  Fort  Smith, 
“Significance  of  Jaundice,”  and  J.  D.  Ri- 
ley, State  Sanatorium,  “Pulmonary  Tuber- 
culosis.” This  being  the  62nd  anniversary 
of  the  Washington  County  Medical  Society, 
H.  D.  Wood,  the  only  living  charter  mem- 
ber of  the  society  spoke,  on  his  62  years  of 
association  with  the  society  as  the  anni- 
versary address. 


Lawrence  County  Medical  Society  and 
the  Woman’s  Auxiliary  met  at  Rio  Vista, 
July  10th,  as  the  guests  of  Dr.  and  Mrs. 
Wm.  Johnson,  of  Hardy.  The  following 
scientific  program  was  presented : “New- 
er Treatment  of  Malaria,”  F.  H.  Jones, 
Piggott;  “Illegal  Practice  of  Medicine,” 
S.  J.  Allbright,  Searcy;  and  “Acute  Ab- 
dominal Infections  in  Children,”  Robert 
Taylor,  Memphis.  A number  of  physi- 
cians from  adjacent  counties  were  pres- 
ent and  all  enjoyed  bathing  in  Spring 
River  and  the  barbecue  supper  served  by 
the  host  and  hostess. 


Personal  and  News  Items 


Recent  publications  are  “The  Technic  of 
Perineoplasty  in  Extreme  Cases  of  Recto- 
cele”  by  Dewell  Gann,  Jr.,  in  The  Missis- 
sippi Doctor,  and  “The  Treatment  of  Ma- 
laria” by  J.  J.  Baker,  in  the  Tri-State 
Medical  Journal. 


Thomas  C.  Watson  was  recently  in- 
stalled as  President  of  the  Benton  Rotary 
Club. 


E.  A.  Buckley,  Bauxite,  took  postgrad- 
uate work  at  Tulane  University  during 
June. 


Charles  Wallis  opened  an  office  at  717 
Donaghey  Building,  Little  Rock,  in  June 
for  the  practice  of  pediatrics. 


J.  Donald  Hayes  and  J.  Harry  Hayes 
have  entered  into  partnership  for  practice 
at  746  Donaghey  Building,  Little  Rock. 

MARRIED — Fontaine  R.  Richardson, 
Fayetteville,  and  Elizabeth  Haney  Porter, 
at  Cane  Hill,  June  12th.  The  Journal  of- 
fers congratulations. 

A.  M.  Gibbs,  Hamburg,  director  of  the 
Ashley  County  Health  Unit,  has  completed 
a special  eight  months’  course  in  public 
health  work.  An  additional  month  was 
spent  on  a traveling  fellowship  studying 
public  health  work  in  Kentucky  and  Ten- 
nessee. 


Fred  Krock,  Fort  Smith,  addressed  the 
Leflore  County  (Oklahoma)  Medical  So- 
ciety in  July  on  “Surgery  of  Pulmonary 
Tuberculosis.” 


Irving  J.  Spitzberg,  Little  Rock,  re- 
ceived the  fellowship  of  the  Academy  of 
Pediatrics  at  the  convocation  at  Cleveland 
in  June. 


Joe  Shuffield,  Little  Rock,  attended  the 
convention  of  the  International  Lion’s 
Club  at  Grand  Rapids,  July  17-20th. 

The  annual  conference  of  the  State 
Board  of  Health  at  Hot  Springs  National 
Park,  July  5th  and  6th,  was  addressed  by 
the  following:  F.  0.  Mahony,  A.  M.  Wash- 
burn and  W.  B.  Grayson. 


August,  1934]  ARKANSAS  MEDICAL  SOCIETY 


53 


E.  T.  Brown  has  moved  from  Lexa  to 
Marvell. 


Gordon  Hastings,  assistant  state  health 
officer,  has  been  awarded  a fellowship  for 
one  year’s  advanced  study  in  public  health 
work  by  the  Rockefeller  Foundation.  Dr. 
Hastings  will  enter  upon  this  work  Sep- 
tember first. 


Dr.  Ruth  Ellis,  who  has  completed  an 
interneship  at  the  Woman’s  Medical  Col- 
lege Hospital,  Philadelphia,  has  returned 
to  Fayetteville  to  be  associated  with  her 
father  in  practice. 

The  Journal  of  the  Medical  Society  of 
New  Jersey  comments  favorably  upon  the 
report  of  the  Publicity  Committee  of  the 
Arkansas  Medical  Society  as  presented  to 
the  recent  annual  session  by  Jerome  S. 
Levy,  Chairman. 

Sam  G.  Daniel,  Marshall,  has  been  ap- 
pointed Chairman  of  the  Farm  Debt  Ad- 
justment Committee  for  Searcy  County. 

<S> 

ANNUAL  FALL  CLINICAL  CONFERENCE  OF 
THE  KANSAS  CITY  SOUTHWEST 
CLINICAL  SOCIETY 


The  Kansas  City  Southwest  Clinical  Society  an- 
nounces the  dates  of  the  Twelfth  Annual  Fall 
Clinical  Conference  October  first  through  fourth, 
Kansas  City,  Missouri. 

Unlike  previous  years,  all  scientific  sessions 
will  be  held  this  year  in  the  President  Hotel, 
starting  each  morning  at  8:30,  and  continuing 
throughout  the  entire  day. 

The  guest  speakers  who  will  participate  in  the 
conference  are  Dr.  Walter  L.  Bierring,  President 
American  Medical  Association;  Dr.  Hugh  Cabot, 
Prof.  Surgery,  Minnesota  Graduate  School  of 
Medicine;  Dr.  Joseph  B.  DeLee,  Prof.  Obstetrics 
and  Gynecology,  University  of  Chicago;  Dr.  Mor- 
ris Fishbein,  Editor,  Journal  American  Medical 
Association;  Dr.  Lee  F.  Hill,  member  American 
Academy  of  Pediatrics;  Dr.  Samuel  Iglauer,  Prof. 
Otolaryngology,  University  of  Cincinnati  College 
of  Medicine;  Dr.  Samuel  A.  Levine,  Associate 
Prof.  Medicine,  Harvard  University  Medical 
School;  Dr.  Philip  Lewin,  Associate  Prof.  Ortho- 
pedic Surgery,  Northwestern  University  Medical 
School;  Dr.  H.  0.  Mertz,  Clinical  Prof.  Genito- 
urinary Surgery,  Indiana  University  School  of 
Medicine;  Dr.  George  E.  Pfahler,  Prof.  Radiology, 
University  of  Pennsylvania  Graduate  School  of 
Medicine;  Dr.  Fred  W.  Rankin,  Past-Prof.  Sur- 
gery, University  of  Louisville;  Reverend  Alphonse 
M.  Schwitalla,  Dean,  St.  Louis  University  School 
of  Medicine,  and  Dr.  H.  W.  Woodruff,  of  the 
Woodruff  Clinic,  Joliet,  111. 

Two  hours  will  be  alloted  each  morning  to 


Sectional  Lectures  pertaining  to  pertinent  medi- 
cal subjects  to  be  presented  by  members  of  the 
society.  Four  of  these  sectional  lectures  will  be 
in  session  simultaneously  each  morning,  so  ar- 
ranged that  there  will  not  be  any  conflict  of 
subjects. 

The  Public  Meeting  of  Monday  evening  will 
bring  as  speakers,  Reverend  Schwitalla,  Dr.  Mor- 
ris Fishbein  and  Dr.  George  Pfahler.  This  meet- 
ing will  be  open  to  the  public  with  admission  by 
ticket  only  and  each  speaker’s  message  promises 
to  be  of  intense  interest  to  the  laymen  as  well  as 
the  physician. 

The  local  medical  societies  will  co-operate  with 
the  Clinical  Society  in  presenting  the  Tuesday 
evening  scientific  session,  with  addresses  by  Dr. 
Samuel  Levine  and  Dr.  Fred  W.  Rankin. 

Arrangements  are  being  made  for  an  evening’s 
entertainment  on  Wednesday  at  the  William  Rock- 
hill  Nelson  Gallery  of  Art  for  the  visiting  doc- 
tors and  their  families.  The  Alumni  and  Presi- 
dent’s Dinners  will  be  the  closing  feature  of  the 
conference. 

Two  of  the  guest  speakers  will  take  part  each 
day  in  the  Round  Table  Luncheon,  each  bringing 
a non-medical  message  which  promises  to  afford 
a few  minutes  relaxation  from  scientific  thoughts. 

Many  features  of  entertainment  are  being 
planned  by  the  women’s  committee  for  the  mem- 
bers of  the  visiting  doctor’s  family  accompanying 
him  to  the  Fall  Conference.  A special  registra- 
tion booth  will  be  available  for  the  women  where 
they  are  urged  to  register  and  obtain  informa- 
tion relative  to  the  women’s  program. 

The  Kansas  City  Society  of  Ophthalmology  and 
Otolaryngology  will  hold  a diagnostic  clinic  Thurs- 
day morning  in  the  President  Hotel  with  addresses 
by  Dr.  Samuel  Iglauer  and  Dr.  H.  0.  Woodruff. 


Book  Reviews 


I Know  Just  the  Thing  for  That.  By  J.  F.  Mon- 
tague, M.  D.,  Director,  New  York  Intestinal  Sani- 
tarium. Price  $2.  Pp.  265.  New  York:  John  Day 
Company,  1934. 

The  author  has  written  a popular  book,  some- 
what weakened  in  its  message  by  an  effort  to 
satisfy  the  sub-title,  “For  patients  without  doc- 
tors and  doctors  without  patience.”  Constipa- 
tion and  its  related  ills  together  with  a multitude 
of  other  subjects,  as  cathartics,  roughage,  diet, 
yeast,  obesity,  health  foods,  and  the  like,  are 
treated  in  a generally  entertaining  style.  The 
work  could  benefit  by  condensation.  The  import- 
ance placed  upon  the  function  of  the  colon  in  gen- 
eral health  by  the  author  appears  to  be  unduly 
stressed. 


New  and  Nonofficial  Remedies,  1934,  contain- 
ing descriptions  of  the  articles  which  stood  ac- 
cepted by  the  Council  on  Pharmacy  and  Chemis- 
try of  the  American  Medical  Association  on  Jan- 
uary 1,  1934.  Price,  $1.50,  postpaid.  Pp.  510. 
Chicago:  American  Medical  Association. 

The  Council  has  made  the  usual  careful  revision 
of  this  popular  handbook,  particularly  of  the 
chapter  on  Arsenic  preparations;  the  article  on 


54 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  3 


Lactic  Acid-producing  Organisms  and  in  the  de- 
scriptions of  Chiniofon  and  Vioform.  The  descrip- 
tion of  Typhoid  Vaccine  has  been  revised  as  to 
combination  dosage  of  typhoid  and  paratyphoid 
organisms  and  for  the  use  of  the  vaccine  in  non- 
specific protein  therapy.  Among  the  new  prep- 
arations included  are:  Aminophylline;  the  new 
alum,  precipitated  diphtheria  toxoid;  Neo-Iopax; 
Benzedrine,  an  ephedrine  substitute;  Autolyzed 
Liver  Concentrate  and  Extralin;  and  Sodium  Mor- 
rhuate.  This  book  deserves  a place  in  every  prac- 
ticing physician’s  library  for  the  wealth  of  ma- 
terial which  it  contains  on  therapeutic  agencies  of 
accepted  worth. 


Modern  Drug  Encyclopedia  and  Therapeutic 
Guide.  By  Jacob  Gutman,  M.  D.,  Phar.  D.,  F.  A. 
C.  P.,  Consulting  Physician,  Manhattan  General 
Hospital;  Director,  Brooklyn  Diagnostic  Insti- 
tute; Instructor  of  Medicine,  New  York  Post 
Graduate  Medical  School  and  Hospital,  etc.  Pp. 
1393.  Price  $7.50.  New  York:  Paul  B.  Hoeber, 
Inc.,  1934. 

This  volume  is  a compilation  of  8610  modem, 
non-pharmacopeal,  medicinal  preparations,  many 
of  which  are  in  general  usage  today.  Each  item 
is  concisely  described  by  statements  taken  from 
standard  works  or  from  information  furnished 
by  manufacturer  or  distributor.  The  arrange- 
ment is  alphabetical,  separate  chapters  being  de- 
voted to  Drugs  of  known  constitution  and  action, 
Effective  combinations,  Preparations  of  unde- 
clared composition,  Endocrine  preparations,  Hy- 
podermic medications,  Biologicals,  Allergens, 
Foods,  Beverages  Mineral  Waters  and  Miscella- 
neous products.  A therapeutic  guide  and  a com- 
prehensive index  complete  the  volume.  The  prac- 
titioner is  afforded  a source  of  information  on 
therapeutic  agents  produced  by  various  firms 
which  may  be  frequently  referred  to  on  products 
of  non-official  character  or  which  are  not  Coun- 
cil-accepted. Information  on  such  agencies  is 
usually  difficult  of  access  and  the  volume  meets 
this  need  of  the  prescribing  physician. 


Fetal,  Newborn,  and  Maternal  Morbidity  and 
Mortality.  Report  of  the  sub-committee  on  Fac- 
tors and  Causes,  Hugo  Ehrenfest,  M.  D.,  Chair- 


man. White  House  Conference  on  Child  Health 
and  Protection.  Pp.  508.  Price  $3.00.  New  York: 
D.  Appleton-Century  Company,  Inc.,  1933. 

A large  group  of  the  better  known  obstetricians 
of  America  have  compiled  the  information  in  this 
volume  and  have  indicated  the  measures  which  are 
necessary  to  effect  improvement  in  maternal  and 
fetal  morbidity  and  mortality.  The  pathology  of 
pregnancy  is  fully  discussed.  The  range  of  sub- 
jects presented  is  wide  and  obstetricians  will  find 
this  a volume  for  critical  study. 


Mystery,  Magic  and  Medicine.  The  Rise  of 
Medicine  from  Superstition  to  Science.  By  How- 
ard W.  Haggard,  M.  D.,  Associate  Professor  of 
Applied  Physiology,  Yale  University.  Pp.  192. 
Price  $1.00.  New  York:  Doubleday,  Doran  and 
Company,  1933. 

The  author  has  proved  himself  capable  of  writ- 
ing this  popular  work  on  medical  history  by  his 
previous  volumes.  Admirers  of  “Devils,  Drugs 
and  Doctor's”  and  “The  Lame,  Halt  and  Blind”  will 
find  this  fully  as  interesting.  Beginning  with  the 
magic  of  primitive  man,  the  author  discusses  the 
gradual  growth  of  medical  knowledge  and  its 
progress  through  superstition,  ignorance  and 
quackery  to  present-day  scientific  medical  prac- 
tice. A glossary  of  proper  names  and  medical 
terms  is  a valuable  small  reference  chapter  in 
itself. 


THE  TULANE  UNIVERSITY 
OF  LOUISIANA 

Graduate  School  of  Medicine 

POSTGRADUATE  instruction  offer- 
ed in  all  branches  of  medicine.  Courses 
leading  to  a higher  degree  have  also 
been  instituted. 

For  bulletin  furnishing  detailed 
information,  apply  to  the 

DEAN 

Graduate  School  of  Medicine 

1430  Tulane  Avenue  New  Orleans,  La. 


J.  L.  Harris 


The  Old  Reliable  Firm 
521  1-2  Main  Street 


Roe  McCranie 

LITTLE  ROCK  ARTIFICIAL  LIMB  CO. 

LIMBS  AND  BRACES  Same  Location  Since  1911 

Phone  5979  Little  Rock,  Ark. 


Granite  Mountain  Hospital 

Open  to  All  Reputable  Physicians  and  Surgeons 
S.  P.  JUNKIN,  M.  D.,  Medical  Director 
Telephone  Rural  9579-F2  Route  4,  Little  Rock,  Ark. 


THE  JOURNAL 


N RA 


of  the  ARKANSAS  MEDICAL  SOCIETY 

PUBLISHED  MONTHLY  UNDER  DIRECTION  OF  THE  COUNCIL 


Vol.  XXXI 


Fort  Smith,  Arkansas,  September,  1934 


No.  4 


THE  RELATIONSHIP  OF  ALLERGY 
TO  OTOLARYNGOLOGY* 
John  J.  Shea,  M.  D. 
Memphis 


The  relationship  of  allergy  to  otolaryng- 
ology  has  assumed  an  important  place  in 
the  modern  set-up  of  our  specialty.  More 
patients  are  recognized  as  being  allergic 
today,  because  of  the  combined  studies  of 
the  allergist  and  the  otolaryngologist. 

The  rapid  rate  at  which  we  live  and  the 
nervous  tension  under  which  we  exist  are 
changing  our  physical  being. 

Heredity  plays  an  important  part,  for 
we  must  be  born  with  a nervous  system 
capable  of  reacting  in  this  peculiar  man- 
ner known  as  allergic. 

ALLERGIC  MANIFESTATIONS 

Allergy — Altered  reactivity. 

Prophylaxis — Favoring  protection. 

Anaphylaxis — Without  protection. 

Immunity — An  excess  of  antibodies  in  the  blood. 

Sensitiveness — An  excess  of  fixed  antibodies 
in  the  tissues  without  the  protection  of  circulat- 
ing antibodies. 

TYPES  OF  ALLERGIC  REACTIONS 

Migraine. 

Vaso-motor  rhinitis. 

Asthma. 

Gastro-intestinal  allergy. 

Eczema  and  Angioneurotic  oedema. 

Heredity 

The  child  is  the  fruit  of  the  family  tree 
and  inherits  a nervous  system  capable  of 
allergic  reactions.  Females  are  more  fre- 
quently allergic  than  males  and  the  trans- 
mission is  twice  as  common  through  the 
females.  In  rabbits,  the  predominating 
allergic  reaction  is  cardiac;  in  the  guinea 
pig  pulmonary;  in  the  dog  hepatic,  while 
in  man,  any  or  all  of  these  organs  may 
show  predominating  reactions. 


* — Read  before  the  Fifty-ninth  annual  session 
of  the  Arkansas  Medical  Society  held  at  Little 
Rock  April  16-18,  1934. 


Buffer  Substances 

The  sodium  and  potassium  salts  of  car- 
bonic, phosphoric,  lactic  and  sulphuric 
acids  comprise  a buffer  system  maintain- 
ing a normal  bio-chemical  balance.  The 
fluids  of  our  body  are  composed  of  solu- 
tions of  weak  acid  and  bases.  When  a 
strong  acid  is  absorbed,  it  immediately 
reacts  with  one  of  these  salts  to  form 
water  acids  and  a neutral  salt.  When  a 
strong  base  is  absorbed,  one  of  the  weaker 
acids  unites  with  it  to  form  a weaker  base. 
By  this  process  the  reaction  of  the  tissue 
fluids  are  controlled.  Our  bio-chemical 
reaction  is  measured  in  equivalence  of  pH. 
The  tests  are  determined  not  on  absolute 
quantities  of  the  acid  and  base  present,  but 
upon  the  relative  amounts  of  these  two 
7.0  pH.  is  the  strength  of  neutral  distilled 
water  and  the  human  limits  are  from  7.0 
to  7.80  pH.,  but  the  ordinary  state  of  the 
body  balance  runs  from  7.30  to  7.0  pH. 
When  the  pH.  rises  above  7.50,  we  speak 
of  the  condition  as  being  alkalosis  and  re- 
actions below  7.30  are  called  acidosis, 
which  is  merely  a relative  acid  state,  for 
the  cell  life  could  not  live  if  the  fluids  be- 
came neutral,  less  acid. 

The  color  of  the  nasal  membrane  cover- 
ing the  septum  is  of  diagnostic  value  for 
when  it  is  pale,  the  sodium  and  chloride 
elements  are  deficient  and  the  body  is  in 
need  of  NaCl,  Cacl2  and  dilute  HC1.,  if 
the  membrane  is  red,  K.  Ca,  and  iodides 
are  deficient.  If  this  membrane  is  dry, 
the  sodium  content  is  in  excess  of  its  nor- 
mal balance  with  the  K.  Should  the  blood 
pressure  be  high,  this  balance  is  restored 
by  the  reduction  of  the  sodium  intake,  but 
if  the  pressure  is  normal  or  low,  the  bal- 
ance may  be  corrected  by  increasing  the 
intake  of  potassium.  So  we  see,  that  the 
sodium  and  potassium  regulate  the  fluid 
balance  and  behavior  of  the  tissues.  Cal- 
cium and  iodine  are  antagnostists.  Ca  is 
given  when  we  desire  to  build  up  tissue 
and  the  iodides  to  break  down  cell  struc- 
tures. 


56 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  4 


Histology 

The  nasal  membrane  is  derived  from 
the  endodermic  layer  of  the  foetus  and  is 
the  most  sensitive  and  responsive  tissue 
of  the  organism.  The  mucous  membrane 
of  the  sinuses  is  less  sensitive  and  respon- 
sive, but  richer  in  lymphatics,  which  ulti- 
mately drain  into  the  bronchial  lymph 
nodes.  The  chest  reflects  the  lymphatic 
activity  of  the  sinuses. 

Nasal  Sites 

There  are  areas  within  the  nose  and 
sinuses  which  are  sensitive  and  responsi- 
ble for  the  beginning  of  the  reflex.  The 
established  nasal  sites  are  the  upper  and 
back  part  of  the  septum,  the  ethmoid  re- 
gion, hyperesthetic  areas  on  the  tubercu- 
lum  and  the  anterior  tips  of  the  middle 
and  inferior  turbinates,  points  of  contact 
between  the  septum  and  the  outer  wall  of 
the  nose,  all  of  the  sinuses  and  the  region 
of  the  sphenopalatine  ganglion.  A re- 
flexed path  from  the  nose  to  the  lungs  is 
recognized,  and  a stimulation  of  it  will 
produce  spasms  of  the  bronchial  tree  or  an 
increased  amount  of  the  bronchial  secre- 
tion. The  most  commonly  encountered  re- 
flexes are  derived  from  nasal  polyps,  con- 
tact made  by  deflected  septums,  especially 
those  involving  the  sensitive  spots  on  the 
septum.  The  hook-up  is  through  the  nasal 
ganglion  with  pressure  being  the  trigger. 

Migraine 

Paroxysmal  attacks  of  headaches  pre- 
ceded by  sensory  irritations,  especially  ocu- 
lar and  followed  by  nausea  and  vomiting. 

Etiology — (a)  Gastro-intestinal  auto-intoxica- 
tion. 

(b)  Cortical  disease. 

(c)  Allergic. 

Onset — Before  or  at  puberty — gradual. 

History — Hereditary — females  and  males. 

Triggers — Menstruation,  worries,  eye  strain 
and  gastro-intestinal  disturbances. 

Pathology — Increase  of  intra-cranial  pressure. 
Felt  first  in  temporal,  parietal  or  occipital  re- 
gion. May  be  limited  to  one-half  of  the  head. 

Sensory  central  symptoms — (a)  Tingling. 

(b)  Numbness. 

Motor  Symptoms — (a)  Drooping  of  an  upper 
eye  lid. 

(b)  Diplopia. 

(c)  Diminution  of  vision. 

(d)  Weakness  of  a limb. 

(e)  Motor  aphasia. 

(f)  Vaso-motor  — pallor 
sweating  — dilation  of 
pupil. 


Viso-Motor  Rhinitis 

Allergic  — Allergens  (a)  Seasonal  — 
spring,  from  trees  and  flowers;  late  sum- 
mer to  frost,  from  weeds,  grasses  and 
flowers. 

(b)  Inhalant  allergens — contact,  face 
powder,  house  dust,  flour,  silks,  dandruff, 
feathers  and  furs. 

(c)  Foods — Barnyard  products,  and 
shell  fish. 


Endocrines — (a) 

(b) 

(c) 

(d) 


Thyroid — hypo-women. 
Ovarian — hypo-women. 
Pituitary  — with  head- 
aches. 

Semitic — characteristic. 


Bio-chemical — Loss  of  sodium. 

X-Ray  Study 

The  initial  films  of  a suspected  case 
may  show  a cloudiness  in  one  or  more  of 
the  sinuses  similar  to  those  of  the  puru- 
lent type,  but  a second  film  made  after 
the  administration  of  a therapeutic  dose 
of  adrenalin  will  eliminate  the  cloudiness, 
if  the  condition  is  allergic. 

Treatment  of  Vaso-Motor  Rhinitis 


The  medical  treatment  of  vaso-motor 
rhinitis  is  based  on  the  re-establishment 
of  the  bio-chemical  balance,  sodium  salts 
of  the  iodides  and  mixtures  of  calcium  and 
phosphorus  being  important.  The  internal 
administration  of  Ephedrine  and  a bar- 
bytal  derivative  is  more  efficacious  than 
the  local  use  of  Ephedrine.  At  one  time 
the  intra-nasal  radiation  of  ultra-violet 
was  thought  to  be  specific,  but  today  it  is 
only  used  in  selected  cases.  “Bernheimer 
and  Cutler  reported,  where  radiation  had 
been  carried  out  on  hyperesthetic  rhinitic 
cases,  that  50  per  cent  were  relieved  one 
year  later.” 

Many  of  the  commercial  nasal  drops 
contain  ephedrine,  which  is  habit  forming 
and  today  we  are  seeing  victims,  who  are 
never  happy  unless  their  membranes  are 
under  the  influence  of  this  Chinese  drug. 

Gastro-Intestinal  Allergy 

Indigestion  allergy — any  food. 

(1)  Barnyard  products — eggs,  butter 
and  milk. 

(2)  Animals — (a)  Chickens — hens  and 
roosters,  (b)  Other  fowls,  (c)  Beef  and 
veal,  (d)  Pork. 


September,  1934]  ARKANSAS  MEDICAL  SOCIETY 


57 


(3)  Sea  foods — Oysters,  clams,  shrimp, 
etc. 

(4)  Vegetables — Nuts,  leafy  vegetables, 
starchy  vegetables,  as  potatoes  and  wheat. 

(5)  Drug  iodiosyncrasy  — quinine, 
iodides,  arsenic — unite  with  the  protein 
of  the  blood  to  produce  an  allergant  pro- 
duct. 

Eczema  and  Angioneurotic  Oedema 

Eczema — Milk  and  feathers,  occupa- 
tional contact  allergens. 

Angioneurotic  oedema — women  — sen- 
sitive to  discharge,  post-operative,  diet, 
shellfish,  orbital  contents,  tongue  and 
throat,  larynx-croup. 

Infections  Associated  With  Allergy 

If  there  occurs  an  increased  alkalinity 
the  result  of  treatment  of  an  acute  infec- 
tious process,  the  bio-chemistry  becomes 
favorable  for  an  allergic  reaction.  The 
presence  of  an  allergic  state  is  not  a con- 
tra-indication to  surgery.  But  on  the 
other  hand,  any  necessary  intra-nasal  op- 
eration would  be  carried  out,  such  as  sub- 
mucous resections  of  obstructive  noses, 
simple  drainage  of  purulent  discharge 
from  out  of  a sinus  will  remove  a trigger. 
For  the  reabsorption  of  sinus  discharge 
often  serves  as  an  allergen.  Radical  pan- 
sinus operations  are  of  value  in  the  hands 
of  the  experienced,  but  should  not  be  un- 
dertaken as  a last  resort. 

Asthma 

A neurosis  causing  a spasm  of  the  bron- 
chial muscles;  a hyperaemia  and  turge- 
scence  of  the  mucosa  of  the  smaller  bron- 
chial tubes  and  a peculiar  exudate  of  mu- 
cin. 

(1)  Cardiac. 

(2)  Renal. 

(3)  Bronchial  or  spasmodic. 

(a)  Allergic. 

(b)  Endocrine. 

(c)  Bio-chemical. 

Modus  Operandi 

Sensitization  to  a bacterial  protein.  Ton- 
silitis  and  pyorrhea.  Eosinophilia.  Re- 
flex from  nasal  contact: — 

(a)  Septum — galvanic  stimulation  and 
cautery. 

(b)  Turbinates — pressure  on  Meckels 
ganglion. 


(c)  Ethmoids — cystic  degeneration,  hy- 
perplasia. 

Absorption  of  sinus  discharge. 
Sensitization  To  Bacteria 

The  allergic  patient  readily  becomes 
sensitive  to  the  bacteria  of  an  acute  or 
chronic  infection,  especially  those  of  the 
sinuses,  whereas,  infection  of  the  gums 
or  tonsils  may  be  tolerated.  In  order  to 
study  this  sensitization,  a culture  should 
be  grown  from  some  of  the  sinus  discharge 
upon  an  agar  media.  This  excludes  the 
possibility  of  any  other  protein  entering 
into  the  test.  A vaccine  is  made  by  sim- 
ply washing  with  normal  saline  and  steril- 
ized by  heat.  A marked  reaction  to  minute 
inoculation  of  this  vaccine  is  proof  of  a 
sensitiveness  to  the  reabsorption  of  the 
nasal  discharge.  The  importance  of  this 
knowledge  is  that  the  sensitive  patients 
may  hope  for  relief  through  their  sur- 
gery, whereas,  those  not  sensitive  can  only 
hope  that  the  removal  of  some  pressure 
will  be  of  value. 

Vagus  Stimulation 

A hyper-irritable  condition  of  the  bron- 
chial vagus,  which  has  been  aggravated  by 
sensitization  to  certain  specific  proteins 
may  be  precipitated  into  an  attack  of 
asthma  by  either  central  or  reflex  stimu- 
lations, the  cause  of  the  stimulus  being  a 
diseased  process  in  other  organs  such  as 
the  nasal  mucous  mebrane,  sinuses,  ear, 
lung  tissue,  stomach  and  intestinal  tract, 
gall-bladder,  genitalia,  bladder  and  impact- 
ed third  molar. 

Etiology 

(1)  Allergic  manifestation. 

(2)  Allergic  asthma. 

(a)  Seasonal — Spring  from  trees  and 
flowers ; late  summer  to  frost  from  weeds, 
grasses  and  flowers. 

(b)  Inhalant  allergens — Contact,  face 
powder,  house  dust,  flour,  silks,  dandruff, 
feathers  and  furs. 

(c)  Foods — Barnyard  products,  and 
shell  fish. 

Endocrines — ( a ) Thyroid — hypo-women. 

(b)  Ovarian — hypo-women. 

(c)  Pituitary — with  headaches. 

(d)  Semitic — characteristic. 

Bio-chemical — Loss  of  sodium. 


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[Vol.  XXXI,  No.  4 


OSLER 

Osier  defined  hay  fever  and  asthma  as 
“a  reaction  of  an  anaphylactic  nature  in 
sensitized  persons,  in  others  possibly  a re- 
flex neurosis,  characterized  by  a swelling 
of  the  nasal  or  respiratory  mucous  mem- 
brane, increased  secretion,  and  in  asthma, 
spasm  of  the  bronchial  muscle  with  dys- 
pnoea, chiefly  expiratory.  There  are  no 
essential  differences  between  hay  fever 
and  asthma;  in  one,  nasal  portion  of  the 
respiratory  tract  is  affected,  in  the  other 
bronchial.  Many  times  both.” 

Mullin’s  Classifications 

1.  Those  due  to  sensitization  to  pol- 
len, food  and  other  proteins. 

2.  Those  due  to  infection  in  the  para- 
nasal sinuses, 

3.  Those  due  to  reflex  stimulation. 

It  should  be  understood  that  in  any  in- 
dividual case  a combination  of  these  causes 
may  be  responsible.  Infections  of  the  ton- 
sils or  pyorrhea  are  less  likely  to  cause 
asthma  than  infections  in  the  ethmoid  or 
maxillary  sinuses. 

Asthma  As  a Toxemia  (Tobey) 

Faulty  proteid  metabolism  with  excess 
of  carbohydrates  in  the  diet. 

Toxemia  alters  the  asthmatic. 

Nasal  disease  (ethmoid)  supplies  the 
spark. 

Weille 

Dr.  Francis  L.  Weille  in  an  extensive 
study  at  the  Massachusetts  Eye  and  Ear 
Infirmary  followed  several  hundred  cases 
of  asthma  and  found  the  pathology  within 
the  nose  to  be  as  follows : 


Intrinsic.  Extrinsic.  Reflex. 

Cases  32  6 1 

Polypoid  70%  50% 

Purulent  and 

Polypoid  49%  50% 


INTRINSIC — Cysts  9% — thickened  sinus  mem- 
brane 10% — polyps  40% — marked  fibroma  9% 
— cystic  degeneration  10%. 

Many  over-lapped. 

A study  of  the  sinuses  involved  showed  the  fol- 
lowing : 

Sinus.  Single.  Bilateral. 

Maxillary  7 32 

Ethmoid  2 26 

Frontal  3 17 

Sphenoid  0 15 

One  or  more  sinuses  were  involved. 
Weille’s  conclusions  were  that  50  per 


cent  of  the  asthmatic  patients  received  long 
relief  from  sensible  sinus  surgery  and  75 
per  cent  of  the  nasal  symptoms  were 
cured.  If  the  asthma  was  extrinsic,  the 
surgery  failed  to  cure  in  the  presence  of 
the  extrinsic  factor. 

Treatment  of  Asthma 

Morphine  and  its  derivatives  should  be 
avoided  by  these  patients,  as  its  adminis- 
tration is  dangerous. 

The  first  step  is  the  complete  testing  by 
a competent  allergist,  which  should  include 
foods,  inhalants  and  vaccines  of  the  ordi- 
nary respiratory  type.  After  the  testing 
has  been  completed,  the  patient  is  advised 
to  avoid  or  eliminate  all  products  that 
can  be  taken  care  of  in  this  manner.  If 
however,  the  patient  is  sensitive  to  cer- 
tain products,  which  cannot  be  avoided 
such  as  wind-born  pollens,  an  antigen 
composed  of  these  clinically  important 
pollens  should  be  administered.  The  clin- 
ical importance  varies  according  to  the 
different  parts  of  the  country,  for  in  the 
extreme  Southern  States,  pollenization 
lasts  nine  (9)  months. 

The  diet  should  include  sufficient 
amount  of  the  foods  whose  ash  is  acid. 
The  addition  of  dilute  hydrochloric  or  ni- 
trohydrochloric  acid  to  the  protein  meals 
will  aid  in  maintaining  a favorable  pH. 
balance.  A patient  who  is  hyper-alkaline 
reacts  allergically  more  violently,  than  one 
whose  pH.  is  low. 

Desensitization — Neutralizing  the  fixed 
antibodies  by  repeated  administration  of 
small  doses  of  the  antigen  over  a long 
period  of  time. 

Immunization,  by  spaced  injections  of 
graduated  doses  of  the  antigen,  an  excess 
of  the  circulating  antibodies  is  acquired. 
This  has  been  of  great  value  in  the  sinus 
type,  where  each  acute  cold  precipitates 
an  allergic  attack. 

Surgery — Removal  of  focal  infections  is 
important,  for  these  patients  readily  be- 
come sensitive  to  the  offending  organism 
present  in  the  focus  of  infection,  especial- 
ly the  maxillary  and  ethmoidal  sinuses. 

The  allergist,  who  treats  bronchial 
asthma  without  considering  the  possibil- 
ity that  the  nose  and  the  sinuses  may  be 
diseased  or  the  rhinologist  who  does  not 
consider  the  possible  presence  of  allergy 
will  alike  meet  with  failure. 


September,  1934]  ARKANSAS  MEDICAL  SOCIETY 


59 


The  surgery  may  be  (a)  Plastic — as  a 
submucous  resection,  when  a deflected 
septum  serves  as  an  obstruction  to  the 
enlargement  of  the  turbinates. 

(b)  Intra-nasal — antrumotomies  with 
tube  drainage,  ethmoidectomy,  sphenoid- 
ectomy  and  rarely  intra-nasal  drainage  of 
the  frontal  sinuses. 

(c)  Radical — When  the  surgeon  is  sat- 
isfied in  his  mind  the  sinus  pathology  is 
serving  as  a trigger  for  the  allergic  at- 
tack and  he  has  failed  to  gain  permanent 
relief  with  intra-nasal  surgery,  he  is  just- 
fied  in  advising  complete  removal  of  the 
allergic  sinus  membrane.  The  results  ob- 
tained will  depend  upon  whether  the  pa- 
tient is  sensitive  to  the  organism  in  this 
membrane  and  the  competency  of  the  sur- 
geon to  do  a complete  operation. 

A temporary  or  permanent  change  of 
environment,  and  recognition  and  elimina- 
tion of  extrinsic  factors  so  far  as  possible 
should  be  carried  out  before  sinus  surgery 
is  advised;  but  surgery  should  not  ordi- 
narily be  advised  as  a last  resort. 

Conclusions 

The  present  study  indicates  that  patients 
having  polyps  in  the  sinuses  and  nose,  and 
patients  having  purulent  cystic  degenera- 
tion of  sinus  mucous  membrane  are  the 
most  favorable  patients  for  operation,  so 
far  as  the  asthma  is  concerned,  but  the 
latter  condition  cannot  be  diagnosed  pre- 
operatively.  Purulent  sinusitis  is  less  fav- 
orable than  sinuses  showing  polypi. 

Patients  having  extrinsic  asthma  re- 
ceived no  benefit  to  their  asthma  from 
sinus  surgery,  nor  do  patients  having 
slightly  or  moderately  thickened  sinus  lin- 
ings. However  “the  worse  the  sinus  dis- 
ease, the  greater  the  benefit  to  the 
asthma,”  is  not  necessarily  true.  Pa- 
tients who  have  had  drastic  sinus  surgery 
without  benefit  to  their  asthma  are  usual- 
ly no  better  by  “doing  over”  the  sinus  op- 
eration, such  efforts  discredit  nasal  sur- 
gery. 

Indication  for  sinus  operation  in  asth- 
matic patients  include: 

(a)  Sinus  disease  demanding  surgical 
treatment  on  its  own  merits. 

(b)  Recurrent  head  colds  precipitating 
asthmatic  attacks ; the  aim  of  surgery  is 
to  lessen  the  number  of  such  colds. 


(c)  Attempting  to  interrupt  the  vicious 
downward  cycle  in  the  very  severe  case  of 
asthma  by  attempting  to  gain  even  tem- 
porary relief. 

(d)  Cases  in  which  removal  of  polypi 
or  sinus  irrigation  yields  temporary  ben- 
efit. 

The  sinuses  most  often  affected  are  the 
ethmoids,  sphenoids  and  antra,  rarely  the 
frontal  s. 

These  operations  are  not  always  suc- 
cessful because  the  patient  is  not  sensitiz- 
ed to  his  own  sinus  organisms,  or  because 
the  operative  work  is  not  thorough  enough. 
These  cases  are  rare,  but  brilliant  results 
follow  relief  of  the  sinus  infection  by 
operation. 

BIBLIOGRAPHY 

Bernheimer,  L.  B.,  M.  D.,  and  Cutler,  Max,  M. 
D.,  (Chicago)  Archives  of  Otolaryngology,  17: 
658  (May)  1933. 

Weille,  Francis  L. : Studies  in  Asthma.  Amer- 
ican Medical  Association  Journal.  January  28, 
1935;  P.  241. 

Hurd,  Lee  M.:  Asthma  in  Relation  to  Nasal 
Sinusitis.  Archives  of  Otolaryngology.  April 
1933;  P.  557. 

Mullin,  W.  V.,  Cleveland,  Ohio:  “A  Rhinologi- 
cal  Aspect  of  Bronchial  Asthma.” 

Tobey,  H.  G.:  The  Relation  of  the  Nasal  Sinuses 
to  Asthma.  Archives  of  Otolaryngology.  De- 
cember 1931 ; P.  784-789. 

DISCUSSION 

Alan  G.  Cazort,  Little  Rock:  I enjoyed  this 

excellent  paper.  I find  a lot  of  things  to  agree 
with  and  a few  things  to  disagree  with.  I wish 
that  Dr.  Shea  had  said  more  about  the  differen- 
tiation in  vasomotor  rhinitis  cases.  I want  to 
ask  a question  or  two.  One  of  them  is  as  to  the 
importance  of  the  eosinophiles  in  nasal  smear 
in  differentiation.  And  the  other  is  the  status 
of  bacterial  allergy  in  vasomotor  rhinitis;  wheth- 
er the  patient  becomes  sensitized  to  the  bacterial 
proteins  which  normally  grow  in  the  nose  and, 
if  so,  whether  we  can  desensitize  the  patient  to 
those  proteins,  using  about  the  same  methods  we 
do  in  desensitizing  to  the  pollens? 

Dr.  Shea,  in  Response:  We  are  pleased  in  the 

study  of  the  case  that  we  suspect  as  being  allergic 
when  the  smear  of  the  nasal  secretion  carries  as 
high  as  10%  of  eosinophiles.  It  is  better  still 
if  the  polypi  that  we  remove,  or  the  membrane 
we  take  within  the  sinus  is  rich  in  eosinophiles. 
The  trained  eye  can  differentiate  an  allergic  mem- 
brane, but  the  differentiation  between  a case  that 
is  allergic  and  one  that  is  hypo-endocrine  is  dif- 
ficult to  make.  As  to  when  the  patient  will  get 
sensitized  is  difficult  to  understand.  I believe 
personally  that  it  is  the  change  in  his  bio-chemi- 
cal reaction  that  makes  him  susceptible. 

I wish  to  thank  you  for  your  invitation,  atten- 
tion and  discussion. 


60 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  4 


EVALUATION  OF  THE  SWIFT-ELLIS 
THERAPY  IN  THE  TREATMENT 
OF  NEUROSYPHILIS* 

Grayson  E.  Tarkington,  M.D.,  F.A.C.P. 
Formerly  Director  Charles  Steinberg- 
Clinic,  Hot  Springs  National 
Park. 


During  the  ten-year  period  that  the 
Neurosyphilis  Clinic  of  the  Charles  Stein- 
berg Clinic  has  been  in  operation,  the 
members  of  the  staff  have  noted  that  there 
has  been  an  unusually  large  number  of 
readmissions  for  a clinic  whose  clientele 
is  almost  entirely  transients.  On  Janu- 
ary first,  1932,  a chart  was  devised  which 
would,  in  a measure,  show  the  results  we 
were  obtaining  with  our  efforts.  These 
were  astounding,  even  to  those  working  in 
the  clinic  daily.  While  being  aware  of 
the  fact  that  we  were  obtaining  satisfac- 
tory results,  we  were  much  surprised  at 
the  splendid  showing  presented  in  the  ac- 
companying table. 

The  majority  of  the  syphilis  patients 
entering  the  Charles  Steinberg  Clinic  are 
transferred  to  us  from  the  United  States 
Health  Service  Clinic  as  intraspinous 
therapy  is  not  given  there.  After  a com- 
plete neurological  and  physical  examina- 
tion, the  patient  receives  a diagnostic 
spinal  puncture.  If  the  fluid  and  physical 
examinations  are  found  to  be  negative,  the 
patient  is  returned  to  the  Government 
Clinic  for  so-called  routine  “systemic” 
treatment.  If  the  fluid  is  positive,  this 
fact  and  the  physical  and  neurological 
findings  are  correlated,  the  patient  classi- 
fied according  to  the  following  classifica- 
tion and  treatment  is  instituted : 

Group  I.  Preponderantly  Meningeal  Neuro- 
spyhilis.  (This  group  includes  most  of  the  early 
cases  of  involvement  of  the  nervous  system.) 

A.  Acute  Syphilitic  Meningitis.  Occurring 
in  untreated  syphilis,  manifesting  the  charac- 
teristic signs  of  meningitis  with  the  accom- 
panying signs  of  a recent  early  syphilis. 

B.  Neuro-recurrence.  Evidence  in  inade- 
quately treated  patients  by  various  clinical 
manifestations,  usually  a subacute  meningitis 


(*— -From  the  Department  of  Syphilis,  Charles 
Steinberg  Clinic,  Leo  N.  Levi  Memorial  Hospital, 
Hot  Springs  National  Park,  Arkansas.  Read  be- 
fore the  fifty-eighth  annual  session  of  the  Arkan- 
sas Medical  Society  held  in  Hot  Springs  Na- 
tional Park,  May  2,  3,  4,  1933.) 


with  or  without  focal  cranial  nerve  lesion  (seen 
in  2 to  5 per  cent  of  syphilitics). 

C.  Mild  Meningeal  Neurosyphilis.  Mani- 
fested by  mild  symptoms  or  slight  physical 
signs;  headache,  neuralgic  pains,  insomnia, 
vertigo  or  nervousness. 

D.  Asymptomatic  Neurosyphilis.  Patients 
have  no  complaint  and  show  no  physical  ab- 
normalities. Only  abnormalities  in  spinal  fluid 
— a finding  in  about  20  per  cent  of  all  early 
syphilitics. 

Group  II.  Preponderantly  Vascular  Neurosyph- 
ilis. (Late  meningovascular  neurosyphilis.) 

A.  Cerebrospinal  Syphilis.  Evidence  of  en- 
darteritic  focal  lesions  with  occasional  cranial 
nerve  disorder,  hemiplegia  and  various  tran- 
sient paralytic  phenomena. 

B.  Cerebral  Syphilis. 

C.  Arteriosclerosis. 

D.  Syphilitic  Epilepsy. 

E.  Brain  Gumma.  Single,  presenting  local 
signs  of  tumor;  multiple,  presenting  the  symp- 
tomatology of  a diffuse  neurospyhilis. 

F.  Syphilitic  Tranverse  Myelitis.  Paraple- 
gia and  syphilitic  chronic  anterior  poliomye- 
litis. 

Group  III.  Preponderantly  Parenchymatous 
Neurosyphilis. 

A.  Paresis  (Neurosyphilis  plus  a Psycho- 
sis). (1)  The  organic  or  deteriorated;  gross 
mental  deterioration,  impaired  judgment,  cloud- 
ed sensorium,  grave  personality  changes.  (2) 
An  organic  reaction  with  a psychosis  of  a func- 
tional coloring.  (3)  Cases  without  the  signs 
of  deterioration  of  general  paresis. 

B.  Tabes. 

C.  Tabo-Paresis. 

D.  Late  Asymptomatic  Neurosyphilis  or 

Paresis.  (These  are  cases  exhibiting  minor 
neurologic  signs  and  symptoms  which  may  and 
frequently  do  occur  in  normal  as  well  as  in 
syphilitic  persons — headache,  insomnia,  pupil- 
lary and  reflex  disturbances — but  whose  oc- 
currence in  a patient  with  a history  of  syphilis 
is  presumptive  evidence  of  the  existence  of 
neurosyphilis.)  * 

E.  Primary  Optic  Atrophy. 

F.  Congenital  Neurosyphilis. 

The  technic  of  the  Swift-Ellis  therapy 
as  employed  in  our  clinic  is  as  follows: 

The  patient  is  placed  on  mercury  and  iodides 
for  a period  of  one  week  or  ten  days  as  a pre- 
caution against  any  vascular  accidents.  He  is 
then  given  0.4  gm.  arsphenamine  (old).  We  use 
the  straight  arsphenamine  routinely.  From  five 
to  fifteen  minutes  after  this  Injection,  20  or  30 
cc.  of  blood  are  withdrawn  and  placed  into  a 
sterile,  50  cc.  centrifuge  tube  so  if  proper  separa- 
tion of  the  clot  does  not  occur  the  specimen  may 
be  centrifuged.  This,  however,  is  rarely  found 
to  be  necessary.  The  blood  is  then  allowed  to 
stand  for  twenty-four  hours  at  room  tempera- 
ture. At  the  end  of  that  time,  10  to  12  cc.  of 
the  serum  are  pipetted  off  and  placed  in  a sterile 


September,  1934]  ARKANSAS  MEDICAL  SOCIETY 


61 


tube.  The  serum  is  inactivated  in  a water  bath 
at  56°  C.  for  thirty  minutes  and  is  then  ready 
to  inject  into  the  spinal  canal.  The  apparatus 
used  for  the  spinal  treatment  is  the  barrel  of  a 
20  ce.  Luer  syringe  with  about  16  inches  rubber 
tubing  attached  to  it.  At  the  other  end  of  the 
tubing  is  attached  a glass  adapter  or  window, 
one  end  of  which  has  been  ground  to  fit  the  Luer 
type  of  needle.  The  patient  is  placed  in  the  re- 
cumbent position  and  spinal  puncture  is  made 
in  the  lumbar  region.  Manometeric  readings  are 
made,  enough  spinal  fluid  is  removed  for  exami- 
nation and  at  least  to  equal  the  amount  of  se- 
rum to  be  introduced.  Then  the  glass  window 
with  the  tubing  is  attached  to  the  spinal  needle 
and  enough  spinal  fluid  is  permitted  to  flow  into 
the  barrel  to  remove  the  air;  not  that  the  intro- 
duction of  air  would  do  any  harm  but  this  pro- 
cedure facilitates  free  flowing  of  the  fluid.  The 
serum  is  then  poured  into  the  barrel  of  the 
syringe  and  allowed  to  flow  into  the  intraspinal 
space  by  gravity.  Two  to  3 cc.  of  normal  saline 
solution  are  used  to  wash  the  syringe  and  tubing 
clear  of  the  serum  so  that  the  full  amount  is 
utilized.  The  patient  is  then  permitted  to  go 
home  with  instructions  to  lie  down  until  the  fol- 
lowing morning.  Reactions  from  these  treat- 
ments are  rare  but  when  they  do  occur,  they  con- 
sist principally  of  shooting  pains  in  the  legs,  in- 
dicating cord,  irritation.  We  have  not  had  a 
single  accident  resulting  in  permanent  injury 
from  this  method. 

I have  the  records  of  100  unselected  pa- 
tients to  present  (Table  I).  These  pa- 
tients represent  the  readmissions  from 
January  1,  1932,  to  December  31,  1932. 
The  average  age  of  these  patients  was 
42.39,  with  a representation  of  a low  age 
of  18  and  a high  age  of  55.  The  average 
number  of  cells  on  admission  was  83.3. 
This  represents  a low  count  of  1 and  a high 
count  of  1,125.  The  average  rest  period 
between  treatments  was  10.46  months, 
representing  as  low  as  six  weeks  and  as 
high  as  18  months.  The  average  gain  in 
weight  per  patient  is  rather  deceiving  for 
this  represents  the  greatest  loss  of  23 
pounds  and  the  greatest  gain  of  30 
pounds. 

TABLE  I 

ONE  HUNDRED  RE-ADMITTED  CASES  OF 


NEUROSYPHILIS 

Average  age  of  patient  — — 42.39  years 

Average  number  of  admissions  to 

clinic  — 2.86 

Average  length  of  infection  (before 

admission  to  clinic)  7.2  years 

Average  amount  of  previous  treat- 
ment: Mercury  19.3 

Arsphenamine 14.3 

Number  with  positive  blood  Was- 
sermann’s  on  admission  93. 


Number  with  negative  blood  Was- 


sermann’s  on  admission  7. 

Number  with  positive  spinal  fluid 

on  admission  - 99. 

Number  with  negative  spinal  fluid 

on  admission  _ 1. 

Average  cell  count  of  spinal  fluid 

on  admission  83.3 

Average  amount  of  treatment  re- 
ceived in  clinic: 

Arsphenamine  8.16 

Mercury  33.8 

Swift-Ellis  6.17 

Average  rest  period  between 

treatments  10.46  months 

Number  of  positive  blood  Was- 

sermann’s  on  readmission  60. 

Number  of  negative  blood  Was- 

sermann’s  on  readmission  37. 

Number  without  blood  Was- 

sermann’s  - 3. 

Number  of  positive  spinal  fluids  on 

readmission  | 55. 

Number  of  negative  spinal  fluids 

on  readmission  37. 

Number  without  spinal  tests  on 

readmission  8. 

Average  gain  in  weight  per 
patient Lx - 1-17  Lbs. 


In  Table  No.  II,  it  will  be  noted  that 
the  largest  group  was  that  of  asympto- 
matic neurosyphilis;  next  the  neuro-re- 
currence group.  This,  I believe  is  the  an- 
swer for  an  early  diagnostic  puncture  and 
the  institution  of  treatment. 

TABLE  II 
DIAGNOSIS 

1.  Preponderantly  Meningeal  Neurosyphilis. 


(a)  Neurorecurrence  18 

(b)  Mild  Meningeal  Neurosyphilis  3 

(c)  Asymptomatic  Neurosyphilis  41 

2.  Preponderantly  Vascular  Neurosyphilis. 

(a)  Diffuse  Cerebrospinal  Neurosyphilis  5 

(b)  Syphilitic  Transverse  Myelitis  3 

3.  Preponderantly  Parenchymatous  Neuro- 

syphilis. 

(a)  Paresis  5 

(b)  Tabes  8 

(c)  Late  Asymptomatic  Neurosyphilis  — 16 

(d)  Primary  Optic  Atrophy 1 


In  cases  of  asymptomatic  neurosyphilis 
with  positive  spinal  fluid  we  feel  that 
rather  than  employ  systematic  treatment 
for  a period  of  three  years  and  then  if 
the  spinal  fluid  is  not  negative  to  insti- 
tute intraspinous  therapy;  that  if  the 
Swift-Ellis  plan  is  employed  early  it  will 
avoid,  in  many  instances,  parenchyma- 
tous neurosyphilis.  We  feel  that  our  sue- 


62 


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[Vol.  XXXI,  No.  4 


cess  in  obtaining  satisfactory  results  in 
these  cases  has  been  our  persistence.  The 
Swift-Ellis  method  has  been  abandoned  in 
many  places  as  of  no  value,  when  in  real- 
ity the  method  has  not  been  given  a fair 
trial.  One  course  of  treatment  will  not 
obtain  the  desired  results;  it  frequently 
requires  two,  three  or  more. 

During  the  past  ten  years  we  have  used 
practically  every  method  described  in 
treating  these  cases;  but  we  have  not 
found  any  method  equal  to  the  modified 
Swift-Ellis  therapy  as  we  use  it. 

Summary 

1.  The  results  of  one  hundred  cases 
of  neurosyphilis  treated  with  Swift-Ellis 
therapy  are  reported. 

2.  A classification  of  neurosyphilis  is 
given. 

3.  The  frequency  of  asymptomatic 
neurosyphilis  and  neurorecurrence  is  em- 
phasized. 

4.  Institution  of  intraspinous  therapy 
early  in  the  involvement  of  the  cerebro- 
spinal system  is  urged. 

5.  Repeated  courses  are  often  neces- 
sary. 

BIBLIOGRAPHY 

1.  Johnson,  George  S.:  Clinical  Types  of  Neu- 
rosyphilis, Colorado  Medicine,  May,  1930. 

2.  Lorenz,  William  F. : Neurosyphilis,  Wiscon- 
sin Medical  Journal,  July,  1930. 

3.  Magnus,  Alexander  B. : Syphilis  of  the 

Nervous  System,  Illinois  Medical  Journal,  Vol. 
IX,  No.  4,  (Oct.)  1931. 

DISCUSSION 

Dr.  Geo.  B.  Fletcher,  Hot  Springs:  I think 

after  having  heard  Dr.  Tarkington’s  paper,  and 
having  seen  his  films  and  having  gone  over  the 
tables  and  statistics  he  has  presented,  you  will 
realize  how  much  effort  is  required  to  do  the 
amount  of  work  he  has  presented  here.  If  we  had 
a certain  cure  for  syphilis,  there  would  be  no 
reason  to  continue  to  discuss  it,  but  we  continue 
to  discuss  this  disease  just  as  we  continue  to  dis- 
cuss acute  appendicitis,  malaria,  etc.  ,and  in 
my  opinion  we  obtain  much  benefit  from  these 
discussions.  This  particular  type  of  patient  is 
one  we  see  so  frequently  in  Hot  Springs  and,  of 
course,  you  see  them  at  home. 

There  are  several  points  in  the  paper  I wish 
especially  to  call  your  attention  to.  One  of  the 
most  important  is  the  value  or  the  necessity  of 
early  spinal  puncture  in  leutie  cases.  At  least 
sixty-five  per  cent  of  luetics  will  show  spinal 
fluid  changes  early,  suprisingly  early,  not  a mat- 
ter of  months  but  perhaps  a matter  of  days  or 
weeks  after  the  initial  infection.  That  doesn’t 


necessarily  mean  that  with  a positive  blood  we 
should  immediately  institute  intraspinal  therapy, 
but  it  does  mean  that  we  have  a check  on  that 
patient  early  and  that  later,  after  our  prelimi- 
nary treatment,  we  will  have  a way  of  checking 
up  on  what  has  occurred  in  the  spinal  fluid  after 
that  much  preliminary  treatment.  You,  of  course, 
realize  from  the  film  here  that  preliminary  prep- 
aration of  the  serum  must  be  done  by  some  one 
competent  to  do  it.  It  requires  a good  laboratory 
and  perfect  technic.  On  the  other  hand  you  see, 
as  the  man  walks  from  the  table,  that  it  is  an 
ambulatory  type  of  treatment.  The  patient  isn’t 
laid  up  with  a lot  of  discomfort,  headaches,  etc., 
in  fact,  unfavorable  reactions  to  the  treatment 
are  quite  rare.  I would  be  inclined  to  say  more 
so  than  in  ordinary  intravenous  treatment.  Then 
we  know  that  the  results  are  sufficiently  good  to 
justify  this  type  of  treatment.  We  know  that 
there  are  many  other  things  that  are  suggested 
and  used,  such  as  heat  therapy,  in  the  form  of 
diathermy,  malaria,  etc.,  however,  Dr.  Tarking- 
ton  as  well  as  others  in  other  places  who  have 
reported  on  this  type  of  treatment,  have  such 
definite  statistics  that  we  must  conclude  that 
enough  good  is  accomplished  to  justify  continu- 
ing its  use. 

You  will  notice  his  mention  of  mercury.  We 
have  never  been  able  and  perhaps  never  shall  be 
able  to  eliminate  mercury,  together  with  iodides, 
in  the  treatment  of  all  types  of  syphilis. 

He  mentioned  the  fact  that  the  asymptomatic 
cases  are  perhaps  in  the  majority,  which  is  an 
important  fact  because  of  this  feature;  a pa- 
tient coming  in  with  perhaps  a negative  blood 
Wassermann,  and  no  evidence  of  organic  in- 
volvement of  the  central  nervous  system,  but  giv- 
ing a positive  history  of  syphilis,  if  properly  in- 
vestigated, may  show  a positive  spinal  fluid.  It 
will  be  our  only  chance  to  determine  whether 
there  is  neurosyphilis  present. 

Gumma  which  he  mentions,  and  which  is  rela- 
tively uncommon,  usually  begins  as  a meningo- 
vascular involvement.  It  is  in  the  meningo- 
vascular stage  that,  if  attacked  properly,  you  will 
preclude  the  later  occurrence  of  gumma  which, 
after  all,  when  fully  organized,  is  nothing  but  a 
benign  tumor,  in  which  the  treponema  can  no 
longer  be  demonstrated  at  this  time.  Of  course 
the  condition  is  treated  as  any  other  brain  tu- 
mor. 

I wish  to  compliment  Dr.  Tarkington  on  the 
preparation  of  his  paper  and  in  bringing  the 
facts  before  us  so  clearly. 

Dr.  D.  W.  Goldstein,  Fort  Smith:  I enjoyed  the 
doctor’s  paper  and  the  discussion  of  intraspinal 
therapy.  Like  Dr.  Fletcher,  I believe  the  time 
for  following  the  stereotyped  formulas  in  the 
treatment  of  syphilis  has  passed,  especially  that 
of  neurosyphilis.  I feel  that  this  is  one  of  the 
best  discussions  of  the  intraspinal  therapy  that 
it  has  been  my  pleasure  to  hear.  I do  not  use 
the  intraspinal  therapy  myself,  but  I am  a fol- 
lower of  other  methods  of  procedure.  The  doc- 
tor stated  that  in  asymptomatic  syphilis  he  gave 
intraspinal  therapy  when  the  spinal  fluid  was 
positive.  I do  not  believe  that  your  first  at- 


September,  1934]  ARKANSAS  MEDICAL  SOCIETY 


63 


tack  should  be  through  intraspinal  therapy.  When 
I first  treat  a case,  I think  of  myself  as  the  in- 
dividual being  treated.  If  I had  asymptomatic 
syphilis,  I would  never  take  intraspinal  therapy 
first.  We  do  know  that  mercury,  arsphenamine, 
tryparsamide  and  other  drugs  are  used.  I would 
certainly  try  these  before  I would  take  intra- 
spinal therapy.  Of  course  if  the  house  begins 
to  fall,  I would  use  intraspinal  therapy  as  a last 
resort. 

The  doctor  also  stated  that  he  divided  his  cases. 
The  negative  blood  cases  were  sent  over  to  the 
public  health  hospital  for  treatment,  and  he  only 
treated  positives.  We  know  that  the  most  seri- 
ous cases  of  neurosyphilis  do  not  show  positive 
findings,  and  often  we  see  those  with  a negative 
spinal  fluid,  especially  the  negative  Wassermann, 
that  are  more  serious  than  we  think.  We  know 
that  the  tendency  of  the  Wassermann  is  to  be- 
come negative,  especially  the  blood  Wassermann, 
and  often  the  spinal  fluid  will  be  positive  and 
the  blood  Wassermann  remain  negative.  We  do 
not  know  if  the  improvement  we  see  in  intra- 
spinal thex’apy  is  really  due  to  an  aseptic  menin- 
gitis produced  by  the  arsphenamine,  or  to  the 
arsphenamine  which  is  given  intravenously. 

I cannot  believe  that  this  is  an  ambulatory 
treatment,  and  I hope  that  you  will  not  go  home 
and  use  this  method  of  treatment  as  an  ambula- 
tory procedure.  I hardly  think  that  a spinal 
puncture  is  an  ambulatory  procedure,  though  I 
know  some  men  use  it  as  such.  In  Dr.  Tarking- 
ton’s  hands,  in  Dr.  Fletcher’s  hands  and  in  the 
hands  of  the  men  of  Hot  Springs,  it  may  be  am- 
bulatory, but  I know  it  wouldn’t  be  ambulatory 
in  mine. 

In  treating  neurosyphilis,  a study  of  the  pa- 
tient before  treatment  should  be  made,  and  if 
this  patient  has  a meningovascular  syphilis  of 
a few  months  duration,  I certainly  would  not 
give  them  intraspinal  therapy  without  using  solu- 
ble mercury  even  before  arsphenamine.  In  any 
case  of  neurosyphilis,  I would  not  think  of  giving 
arsphenamine  without  a preparatory  treatment 
of  mercury  or  bismuth. 

Dr.  Tarkington,  in  closing:  As  to  two  or  three 
points  which  Dr.  Goldstein  mentioned:  First,  I 
did  not  want  to  leave  the  impression  that  we 
merely  start  our  treatment  from  the  serological 
findings.  I mentioned  the  fact  that  all  physical 
and  neurological  findings  plus  the  serological 
findings  are  correlated  when  this  patient  is 
placed  on  treatment.  I agree  that  mercury  should 
precede  arsphenamine  injections.  We  use  that 
method.  Probably  not  as  long  as  Dr.  Goldstein 
uses  it  and  probably  not  as  long  as  it  should  be 
used.  As  I say,  our  patients  in  the  clinic  are 
all  indigent.  In  these  patients  where  money  is 
limited,  we  have  to  push  them  sometimes  faster 
than  we  care  to.  I think  that  is  all  I have  to 
offer.  I have  enjoyed  the  discussions  and  I ap- 
preciate both  Dr.  Goldstein’s  and  Dr.  Fletcher’s 
remarks. 


ADDRESS  ON  THE  62ND  ANNIVER- 
SARY OF  WASHINGTON  COUN- 
TY MEDICAL  SOCIETY* 

H.  D.  Wood 
Fayetteville 


We  have  met  again  in  joint  session  to 
celebrate  that  good  fellowship  that  has 
existed  between  these  two  societies  for 
many  years.  This  happens  to  be  the 
sixty-second  anniversary,  or  was  on  the 
first  Tuesday  in  this  month,  of  the  or- 
ganization of  the  Washington  County 
Medical  Society.  The  meeting  was  held 
in  the  hall  above  the  Mcllroy  Drygoods 
Store  Tuesday,  July  2,  1872.  And  how 
the  names  of  the  men  who  were  entitled 
to  write  “M.  D.”  after  their  names  at 
this  meeting  remain  fixed  on  memory’s 
tablet  after  all  these  years. — Thomas  J. 
Pollard,  William  B.  Welch,  Samuel  F.  Pad- 
dock,  Robert  J.  Carroll,  George  W.  Hol- 
comb, Edward  F.  Brodie,  F.  N.  Little- 
john, John  N.  Lacey,  John  C.  Grace.  Your 
humble  speaker  made  one  of  the  ten  on 
this  occasion. 

It  is  not  often  that  a medical  man  con- 
tinues a member  of  a medical  society  for 
sixty-two  years,  in  active  practice  and 
ready  to  answer  calls  day  or  night.  I 
feel  thankful  that  my  life  has  been  spared 
for  all  these  years  as  I have  seen  more 
progress  made  in  these  sixty-two  years 
than  was  ever  made  in  any  previous  two 
thousand  years  of  the  world’s  history  in 
medicine  and  surgery.  Yet  there  is  room 
for  further  progress  in  medicine  and  sur- 
gery. 

May  I mention  an  instance  of  the  dar- 
ing and  skill  of  a charter  member  of  this 
society?  I refer  to  Edward  F.  Brodie, 
a relative  of  the  great  surgeon,  Sir  Ben- 
jamin Brodie.  Dr.  Ed  Brodie  located  at 
Billingsly,  better  known  to  some  of  you 
as  “Hogeye”  and  was  a protege  of  Dr. 
William  B.  Welch  who  had  a remarkable 
knowledge  of  anatomy  and  was  the  lead- 
ing surgeon  in  the  county.  Dr.  Brodie 
had  made  an  appointment  for  Dr.  Welch 
to  help  in  operating  on  a woman  with  a 
goiter.  The  young  Brodie  was  at  the 
woman’s  house  on  time  and  had  every- 


(* — Address  given  before  the  joint  meeting  of 
Washington  and  Benton  County  Medical  Socie- 
ties at  Cave  Springs,  July  12,  1934.) 


64 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  4 


thing  ready  for  the  operation.  This  was 
before  the  days  of  asepsis  when  it  did  not 
take  much  time  to  get  ready  for  a major 
operation.  Dr.  Welch  got  tied  up  with  a 
case  and  could  not  meet  his  appointment. 
Dr.  Brodie  then  instructed  one  of  the 
neighbor  men  how  to  give  chloroform  and 
did  a successful  thyroidectomy. 

I have  sometimes  felt  that  more  doctors 
located  in  Fayetteville,  thinking  they  were 
surgeons,  than  in  any  other  town.  I well 
remember  years  ago  the  doctor  who  came 
from  the  eastern  part  of  the  state  after 
he  had  been  appointed  railroad  surgeon 
in  a small  town.  He  stood  up  straight, 
dressed  elegantly,  walked  about  in  a dig- 
nified way  and  let  it  leak  out  that  he  was 
the  only  educated  surgeon  in  the  city. 
Notwithstanding  the  fact  that  Dr.  Wil- 
liam B.  Welch  had  lived  in  the  city  for 
more  than  ten  years  and  was  a surgeon 
in  the  Confederate  Army  and  was  the 
Chief  Surgeon  left  in  charge  of  the  wound- 
ed after  the  Battle  of  Prairie  Grove. 

A little  bit  of  surgery  fell  to  the  lot  of 
some  of  us  when  we  would  rather  have 
had  some  doctor  of  more  experience  do 
the  work.  Well  do  I remember  in  the  fall 
of  1881  the  little  girl  ten  years  old  who 
had  been  helping  to  gather  a load  of  corn 
where  the  cockleburs  grew.  When  the 
load  of  corn  had  been  gathered  the  chil- 
dren left  the  field  and  started  to  race 
down  the  road.  The  little  girl  pulled  her 
shawl  closer  around  her  neck,  as  it  was 
a cold  day,  and  started  to  run  with  the 
others.  A bur  was  slightly  attached  to 
the  shawl  and  as  she  ran  it  was  drawn 
into  the  larynx  and  lodged  below  the  vo- 
cal cords.  With  the  laryngoscope  I could 
see  the  bur  very  distinctly.  The  next 
morning  I called  on  all  the  doctors  in  the 
town  to  get  the  use  of  a laryngeal  for- 
ceps; no  one  had  such  an  instrument.  A 
classmate  of  mine,  Dr.  C.  S.  Gray,  said 
that  he  had  a long  uterine  forceps  for 
placing  laminaria  tents,  that  could  be 
heated  and  bent  near  a right  angle  which 
he  thought  would  answer  my  purpose. 
With  this  improvised  instrument  and  the 
laryngoscope  I touched  the  bur  a time  or 
two  but  failed  to  grasp  it.  The  child’s 
condition  became  more  distressing  in  the 
afternoon,  and  for  fear  the  bur  might  be- 
come dislodged  and  drawn  into  the  tra- 
chea and  get  beyond  my  reach,  I decided 


to  do  a tracheotomy.  It  was  getting  late 
in  the  afternoon  and  both  the  doctors, 
whose  help  I had  hoped  to  have,  Drs. 
Gray  and  Pollard,  were  in  the  country.  I 
called  on  two  young  doctors  then,  just 
out  of  medical  college,  Dr.  A.  S.  Gregg 
and  Dr.  Thomas  Quarrels.  The  little  girl 
was  chloroformed,  I made  an  incision  in- 
to the  trachea  and  with  dressing  forceps 
caught  the  bur  at  the  first  effort  and  re- 
moved it  more  easily  than  I had  expected, 
feeling  very  much  relieved.  Many  times 
since  then  have  I called  on  Dr.  Gregg  and 
he  has  never  failed  to  respond  to  my  call. 
Sometimes  I have  been  called  on  by  him 
to  assist  in  a difficult  obstetrical  case  or 
to  help  him  in  a surgical  operation.  In 
fact,  I have  felt  like  he  and  Drs.  Ellis  and 
Mock  were  proteges  of  mine,  until  they 
out-stripped  their  preceptor  in  their  pro- 
fessional progress. 

May  I trespass  on  your  time  and  pa- 
tience by  relating  a case  of  the  only  suc- 
cessful operation  of  its  kind,  ever  done 
in  Washington  County  so  far  as  I know; 
an  operation  that  made  a southern  sur- 
geon famous  throughout  the  world.  I had 
assisted  my  preceptor,  Dr.  B.  F.  Williams, 
twice  in  operating  on  a vesico-vaginal  fis- 
tula, once  while  I was  an  undergraduate 
in  1870,  and  again  in  1873.  Dr.  Williams 
failed  to  get  union.  My  recollection  is 
that  Marion  Sims  succeeded  after  his 
seventh  attempt.  Dr.  Sims  did  his  first 
work  on  negro  women  before  he  succeed- 
ed in  curing  a case  of  vesico-vaginal  fis- 
tula. My  friend,  Dr.  J.  W.  Kennedy,  of 
Philadelphia  told  me  that  no  race  of  peo- 
ple stands  surgical  work  so  well  as  the 
negro  race.  So  surgeons  of  the  south  have 
excellent  opportunities  of  success  in  their 
work.  A medical  friend  of  mine  who  was 
anxious  to  do  surgery,  knowing  that  I 
had  helped  my  preceptor  and  that  I had 
the  instruments  necessary,  said  he  wanted 
me  to  help  him  on  a case  of  this  kind  that 
had  come  to  him  for  relief  of  her  distress- 
ing condition.  It  was  before  we  had  a 
hospital  in  the  city.  A residence  had 
been  rented  where  operations  could  be 
done.  On  the  morning  of  the  operation 
the  doctor  said  he  had  such  a cold  in  his 
head  that  he  wanted  me  to  operate.  I did 
not  know  whether  it  was  a cold  in  the  head 
or  cold  feet.  I found  the  fistulous  open- 
ing near  the  pubic  ramus  and  when  I 


September,  1934]  ARKANSAS  MEDICAL  SOCIETY 


65 


pared  the  edges  of  the  opening  and  start- 
ed to  insert  the  sutures  the  point  of  the 
needle  struck  the  pubic  bone  a time  or 
two.  I felt  quite  anxious  about  the  suc- 
cessful outcome  of  the  case.  The  doctor 
did  not  call  me  when  the  time  came  to  re- 
move the  sutures,  but  he  was  glad  to  tell 
me  that  “we  had  succeeded  in  making  a 
watertight  joint.”  I felt  gratified  with 
the  result. 

I find  on  the  roster  of  the  Washington 
County  Medical  Society  115  names  and 
among  this  number  there  have  been  many 
who  have  done  excellent  surgical  work, 
but  among  this  number,  whom  I have 
been  privileged  to  watch  during  these 
sixty-two  years,  I have  not  felt  like  it 
could  be  said  of  any  one  of  them  what 
John  C.  Dacosta  said  of  Joseph  Pancoast, 
when  he  made  a talk  at  the  celebration 
of  the  50th  anniversary  of  the  Philadel- 
phia Medical  Society  in  1899.  He  said  of 
this  skilful  surgeon:  “He  had  an  eye  as 
swift  as  a flashing  sunbeam  and  a hand 
as  light  as  a floating  perfume.”  Let  us 
hope  that  before  the  Washington  County 
Medical  Society  celebrates  its  Centennial 
that  some  member  of  this  society  who  is 
now  with  us  or  who  will  join  later,  will 
approach  in  skill  and  dexterity  what  Da- 
costa said  of  Joseph  Pancoast,  if  they 
ever  keep  in  mind  the  conservation  of 
human  life. 

May  I mention  but  one  instance  of  the 
progress  in  medical  practice  in  these 
sixty-two  years  that  has  given  me  more 
comfort  and  a higher  appreciation  of  the 
greatest  of  all  professions  than  any  other 
one  thing, — the  perfection  of  a diphtheria 
antitoxin  that  has  saved  the  lives  of  mil- 
lions of  human  beings,  so  easily  adminis- 
tered for  the  cure  of  this  one-time  dread- 
ed disease. 

There  is  one  thing  that  the  Washington 
County  Medical  Society  did  soon  after  it 
was  organized  that  contributed  in  a large 
measure  to  its  high  standing  among  the 
medical  men  of  the  state;  that  was  the 
purchase  of  fifty  copies  of  The  Code  of 
Ethics  of  the  American  Medical  Associa- 
tion, giving  to  each  of  its  members  five 
copies  that  the  members  of  the  society  as 
well  as  the  laity  might  have  a better 
knowledge  of  the  duties  of  physicians  to 
patients,  the  duty  of  patients  to  physi- 
cians, and  of  physicians  to  each  other. 


Well  do  I remember  writing  this  couplet 
in  some  of  the  copies  that  I gave  out: 
“Read  carefully  and  return  that  others 
their  duty  may  learn.”  These  rules  of 
good  conduct  for  medical  men  are  now 
called  Principles  of  Medical  Ethics.  When 
medical  men  in  any  community  live  up  to 
these  rules  there  will  always  be  harmony 
and  good  will  among  medical  men.  May 
I urge  upon  you  the  reading  and  careful 
observance  of  these  rules. 

? 

NEW  LILLY  RESEARCH  LABORATORIES 

The  new  Lilly  Research  Laboratories  are  near- 
ing completion  and  will  be  ready  for  occupancy  in 
early  October. 

Throughout  an  existence  of  nearly  sixty  years 
Eli  Lilly  and  Company  have  been  guided  in  their 
efforts  to  serve  the  professions  by  men  whose 
primary  interest  has  been  the  production  of  med- 
icinal products  for  use  in  prescriptions  written  by 
physicians.  Colonel  Eli  Lilly,  the  founder,  was  a 
skilled  pharmacist  with  an  aptitude  and  enthusi- 
asm for  his  work,  for  making  prescription  sup- 
plies in  new  and  better  ways.  His  son,  Josiah  K. 
Lilly,  throughout  his  connection  with  the  com- 
pany, a period  covering  fifty-eight  years,  has  been 
a persistent  experimenter  who  has  constantly 
sought  to  improve  prducts  and  processes.  To 
him  belongs  the  credit  for  establishing  the  first 
Lilly  research  activities  in  a special  laboratory 
devoted  wholly  to  that  phase  of  the  industry. 

A member  of  the  third  generation  of  the  Lilly 
family,  Eli  Lilly,  grandson  of  the  founder,  is  now 
president  of  the  organization  and  it  is  under  his 
direction  that  the  culminating  point  in  Lilly  re- 
search activities  has  been  attained  through  the 
completion  of  the  magnificent  structure  that  will 
be  formally  opened  in  the  fall.  These  new  lab- 
oratories will  embrace  the  very  latest  facilities  for 
scientific  work  and  they  will  also  reflect  the 
progress  of  modern  medicine.  A broad  and  far- 
reaching  program  has  been  planned  in  keeping 
with  the  spirit  of  medical  research  and  the  aspira- 
tions of  a company  that  since  its  inception  has 
recognized  the  need  for  close  affiliation  of  re- 
search with  practice. 

<S> 

“The  length  that  a single  tapeworm  may  attain 
is  prodigious.  Ordinarily  it  measures  from  4 to 
8 M.  (approximately  from  157  to  315  inches). 
But  Berenger-Feraud  claims  to  have  observed  a 
monster  measuring  74  M.  (about  2,913  inches). 
Such  tapeworms  bid  fair  to  rival  the  sea  ser- 
pent in  length.  A tapeworm  of  normal  dimen- 
sions is  composed  of  from  1,200  to  1,300  segments 
or  proglottides.  The  size  of  these  segments  dwin- 
dles as  they  are  traced  upward  toward  the  head, 
those  nearest  the  head  being  exceedingly  narrow 
and  immature.  A mature  segment  is  from  16  to 
20  mm.  (approximately  from  6/10  to  8/10  inch) 
long  and  from  3 to  7 mm.  (from  1/10  to  3/10 
inch)  broad,”  according  to  Dr.  Claude  Lillingston, 
whose  third  article  of  the  serial  on  “Our  Para- 
sites” discusses  “The  Tapeworm”  in  the  August 
Hygeia. 


66 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  4 


THE  JOURNAL 

OP  THE 

Arkansas  Medical  Society 


Owned  by  the  Arkansas  Medical  Society  and  Published 
under  direction  of  the  Council. 


DR.  W.  R.  BROOKSHER,  Editor 
610  First  National  Bank  Bldg.,  Fort  Smith,  Arkansas 


The  advertising  policy  of  this  Journal  is  governed  by 
the  rules  of  the  Council  on  Pharmacy  and  Chemistry  of 
the  American  Medical  Association. 

All  communications  to  this  Journal  must  be  made  to 
it  exclusively.  Communications  and  items  of  general 
interest  to  the  profession  are  invited  from  all  over  the 
State.  Notice  of  deaths,  removals  from  the  State, 
changes  of  location,  etc.,  are  requested. 


OFFICERS  OF  THE  ARKANSAS  MED1CAE  SOCIETY 


F.  O.  MAHON Y,  President  ....  El  Dorado 

M.  E.  McCASKILL,  Presidtnt-Elect Little  Rock 

A.  M.  ELTON.  First  Vice-President .Newport 

S.  C.  FULMER,  Second  Vice-President Little  Rock 

F.  D.  SMITH,  Third  Vice-President  ......  Blytheville 

R.  J.  CALCOTE.  Treasurer Little  Rock 

W.  R.  BROOKSHER,  Secretary Fort  Smith 


COUNCILORS 

First  District — W.  M.  MAJORS  ....Paragould 

Second  District — S.  .T.  ALLBRIGHT  .......  Searcy 

Third  District — M.  C.  JOHN  Stuttgart 

Fourth  District — C.  W.  DIXON'  ...  Gould 

Fifth  District — L.  L.  PURIFOY  . ..El  Dorado 

Sixth  District — DON  SMITH  ...  Hope 

Seventh  District — GEO.  B.  FLETCHER  Hot  Springs 
Eighth  District — S.  B.  HINKLE  ..  Little  Rock 

Ninth  District — D.  L.  OWENS  ....  ..Harrison 

Tenth  District — S.  J.  WOLFERMANN ...  Fort  Smith 


COMMITTEES : 

((Appointments  expire  in  the  year  indicated.) 

Scientific  Work — L.  L.  Purifoy,  Chairman  ; El  Do- 
rado (1935)  : R.  B.  Robins,  Camden,  (1936)  : W.  R. 
Brooksher,  Fort  Smith  (1937). 

Medical  Legislation — Val  Parmley,  Chairman,  Little 
Rock  (1937):  M.  L.  Norwood,  Lockesburg  (1937):  O. 
L.  Williamson,  Marianna  (1937):  H.  T.  Smith,  Mc- 
Gehee  (1936)  : R.  L.  Smith,  Russellville  (1936)  : A.  S. 
Buchanan,  Prescott  (1935)  ; H,  A.  Dishongh,  Little 
Rock  (1935). 

Health  and  Public  Instruction — W.  B.  Grayson, 
Chairman,  Little  Rock  (1937)  ; S.  W.  Douglas,  Eu- 
dora  (1937)  : B.  M.  Stevenson,  Crawfordsville  (1937)  ; 
H.  K.  Carrington,  Magnolia  (1936)  ; H.  A.  Stroud 
Jonesboro  (1936)  ; J.  H.  Fowler,  Harrison  (1935).  E. 
J.  Munn,  El  Dorado  (1935). 

Medical  Education  and  Hospitals — Joe  F.  Shuffield, 
Chairman,  Little  Rock  (1937)  ; David  Levine,  El  Do- 
rado (1936)  ; J.  B.  Futrell,  Rector  (1935). 

Public  Relations — D.  A.  Rhinehart,  Chairman,  Lit- 
tle Rock  (1937)  : E.  E.  Barlow,  Dermott  (1936)  ; M. 
E.  MeCaskill,  Little  Rock  (1935). 

Medical  Economics — T.  F.  Jones,  Chairman,  Fort 
Smith  (1937):  R.  B.  Robins.  Camden  1937):  J.  E. 
Neighbors.  Stuttgart  (1936)  ; D.  E.  White,  El  Dorado 
(1936):  Roy  Millard.  Dardanelle  (1  935):  A.  C.  Shipp, 
Little  Rock  (1935)  ; R.  M.  Sloan,  Jonesboro  (1935). 

Scientific  Exhibit — F.  H.  Krock,  Chairman,  Fort 
Smith  (3935)  ; H.  King  Wade,  Hot  Springs  National 
Park  (1936)  : W.  E.  Gray,  Jr.,  Little  Rock  (1937). 

Arrangements — (Host  Society  1935  meeting) — D.  W. 
Goldstein,  Chairman.  C.  S.  Holt,  J.  A.  Foltz,  H.  Moul- 
ton, M.  E.  Foster,  W.  G.  Elberle,  I.  F.  Jones. 

Necrology — W.  H.  Mock,  Chairman,  Prairie  Grove 
(1935)  : J.  M.  Lemons.  Pine  Bluff  (1936)  ; H.  Moul- 
ton. Fort  Smith  (1937). 

Auxiliary — L.  J.  Kosminsky,  Chairman,  Texarkana 
(1935)  : H.  T.  Wootton,  Hot  Springs  National  Park 
(1936)  : C.  S.  Holt,  Fort  Smith  (1937). 

Cancer  Control — D.  W.  Goldstein,  Chairman,  Fort 
Smith  (1937)  ; R.  L.  Saxon.  Little  Rock  (1936)  : L. 
A.  Purifoy,  El  Dorado  (1935). 


THE  THERAPY  OF  MALARIA. 

An  abstract  from  the  third  general  re- 
port of  the  Malaria  Commission  of  the 
League  of  Nations  has  been  sent  out  from 
Amsterdam,  emphasizing,  probably  in  a 
none  too  altruistic  manner,  the  advantages 
of  quinine.  The  viewpoint  of  the  Malaria 
Commission  is  that  quinine  is  the  best 
drug  for  prophylactic  use  and  that  the 
curative  effect  of  quinine  and  atabrine  is 
equal. 

For  nearly  one  hundred  years  malaria 
therapy  and  quinine  were  synonymous. 
The  World  War  with  its  embargoes  so  cut 
off  the  supply  of  quinine  to  Germany  that 
synthetic  anti-malarial  drugs  were  of  ne- 
cessity produced.  These,  as  finally  per- 
fected, are  Plasmochin  (1925)  and  Ata- 
brine (1930).  The  former  is  the  most  ef- 
fective agent  for  destruction  of  the  sexual 
parasitic  form  and  prevents  the  crescent 
carrier  in  the  estivo-autumnal  type  from 
infecting  mosquitoes.  The  merits  of  Ata- 
brine are  its  toxic  effect  on  the  ring  form 
of  the  parasites,  the  smaller  dosage  and  the 
shorter  course  of  therapy  (1(4  grains 
three  times  a day  for  5 successive  days 
in  tertian  or  quartan  type;  in  the  estivo- 
autumnal  type,  Plasmochin  in  1/6  grain 
doses  three  times  a day  is  added). 

Quinine  therapy  in  its  now  generally 
standardized  form  has  been  quite  success- 
ful for  many  years,  yet  there  are  failures. 
Experimentation  has  shown  that  quinine 
is  insufficient  in  destroying  the  sexual 
parasitic  forms  so  as  to  prevent  mosquito 
infection  and  subsequent  human  infection. 

The  efficiency  of  the  types  of  treatment 
now  available  has  been  studied  through  the 
analysis  of  over  5,000  cases,  treated  with 
various  combinations  of  drugs  in  different 
parts  of  the  world.  Insofar  as  the  length 
of  fever  in  an  acute  attack  is  concerned, 
the  three  drugs  exhibit  little  difference. 
Ring  forms  disappeared  from  the  blood 
after  atabrine  in  2-3  days  (at  times,  after 
more  than  one  course)  ; after  quinine,  in 
6-8  days;  after  atabrine  and  plasmochin, 
1-3  days  and  after  quinine  and  plasmochin, 
in  from  1-1(4  days.  With  the  sexual  forms 
the  peripheral  blood  was  cleared  by  ata- 
brine alone  in  4 per  cent,  by  quinine  (com- 
plete course)  in  15  per  cent,  by  atabrine 
and  plasmochin  in  96  per  cent  and  by  qui- 
nine and  plasmochin  in  75  per  cent  of  all 


September,  1934]  ARKANSAS  MEDICAL  SOCIETY 


67 


cases.  Approximately  25  per  cent  of  qui- 
nine-treated cases  have  relapses,  5 per  cent 
of  the  atabrine  and  plasmochin-treated 
cases  and  from  10-20  per  cent  of  the  qui- 
nine and  plasmochin-treated  cases. 

Thus,  while  the  ideal  malaria  thera- 
peutic agent  has  not  yet  been  discovered, 
it  would  appear  that  the  newer  synthetic 
preparations  are  steps  along  the  road  to 
its  eventual  disclosure. 


Editorial  Comment 


Members  of  the  Arkansas  Medical  So- 
ciety are  urged  to  co-operate  with  the  State 
Board  of  Health  by  making  more  definite 
and  detailed  the  cause  of  death  as  given  on 
death  certificates.  The  Bureau  of  Census 
is  returning  an  excessive  number  of  death 
certificates  to  Arkansas  as  incomplete  and 
is  requesting  additional  information  from 
the  attending  physician.  Dr.  Grayson  has 
recently  mailed  a copy  of  the  Physician’s 
Pocket  Reference  to  the  International  List 
of  Causes  of  Death  to  each  physician  in  the 
state  and  has  asked  their  co-operation. 
Compliance  with  the  regulations  and  the 
standard  list  of  causes  of  death  contained 
in  this  booklet  will  lighten  the  work  in  the 
Arkansas  Bureau  of  Vital  Statistics  and 
measurably  increase  its  standard  of  effi- 
ciency. Keep  this  booklet  readily  avail- 
able and  refer  to  it  when  occasion  calls  for 
the  completion  of  a death  certificate. 

At  a meeting  of  the  Council  of  the  Ark- 
ansas Medical  Society  August  1st,  the  fol- 
lowing committee  was  appointed  as  an  Ad- 
visory Committee  from  the  Society  to  the 
Emergency  Relief  Administration:  M.  E. 
McCaskill,  Chairman;  S.  J.  Wolfermann, 
S.  B.  Hinkle,  D.  A.  Rhinehart  and  W.  R. 
Brooksher.  This  committee  is  encouraged 
by  the  reception  accorded  its  suggestions 
made  to  the  Relief  Administration  and  is 
hopeful  that  by  further  conferences  a more 
satisfactory  and  equitable  system  for  med- 
ical relief  may  be  arranged.  Acting  on  the 
suggestion  of  the  Administration,  a fee 
schedule  has  been  presented  for  consid- 
eration which  the  committee  feels  is  fair 
and  just  for  the  medical  profession  of 
Arkansas.  As  yet  no  action  has  been  tak- 
en on  this  but  we  are  hopeful  that  a favor- 
able decision  may  be  reported  to  the  mem- 
bers at  an  early  date. 


Proceedings  of  Societies 


The  Southeast  Arkansas  Medical  So- 
ciety met  in  Hamburg  July  16th  for  a pro- 
gram by  the  following  speakers:  F.  0. 

Mahony,  A.  C.  Kirby,  W.  T.  Lowe,  Gor- 
don Hastings  and  C.  P.  Gray.  C.  E. 
Spivey,  of  Crossett,  was  host  for  the 
meeting. 


The  Sixth  Councilor  District  Medical 
Society  will  meet  at  Hope,  September  11. 
The  following  program  will  be  presented, 
beginning  at  10 :00  A.  M. : 

Pneumonia  — It’s  Complications  and 
Treatment — Phil  McNeil,  Oklahoma  City. 

Common  Skin  Diseases — D.  W.  Gold- 
stein, Fort  Smith. 

Osteomyelitis  — Willis  C.  Campbell, 
Memphis. 

Cancer  of  the  Cervix — M.  Smith  and 
Joseph  Kelso,  Oklahoma  City. 

Some  Diagnostic  Problems  in  Diseases 
of  the  Lungs — Sam  E.  Thompson,  Kerr- 
ville,  Texas. 

Luncheon  will  be  served  at  noon  and  in 
the  evening  Dr.  Sam  E.  Thompson  will 
address  a public  meeting  on  “Health 
Problems  Are  Individual  Responsibili- 
ties.” 


Members  of  the  Jefferson  County  Med- 
ical Society  were  guests  of  the  Davis  Hos- 
pital at  a banquet  held  at  the  Hotel  Pines, 
Pine  Bluff,  on  August  7th.  Reports  of 
hospital  progress  and  entertainment  num- 
bers featured  the  meeting. 

The  Independence  County  Medical  So- 
ciety were  guests  of  Dr.  and  Mrs.  Frank 
A.  Gray  for  a boat  excursion  and  supper 
on  the  White  River  in  July. 

Mississippi  County  Medical  Society  met 
at  Blytheville  August  7th  for  the  following 
program : 

The  Use  of  Sodium  Thiocynate  in  Dysen- 
tery— L.  D.  Massey,  Osceola. 

Some  Practical  Points  in  Gynecological 

Treatment — Percy  Wood,  Memphis. 
The  Obstructing  Prostate — T h o s.  D. 

Moore,  Memphis. 

The  Blytheville  Hospital  entertained  the 
society  at  a watermelon  feast  at  the  con- 
clusion of  the  program. 

F.  D.  Smith,  Secy. 


68 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  4 


The  Tri-County  Clinical  Society  met  in 
Arkadelphia  on  July  26.  The  program, 
by  speakers  from  Little  Rock,  included  S. 
F.  Hoge  on  “Early  Syphilis";  Paul  Ma- 
honey on  “Differential  Diagnosis  Between 
Otitis  Media  and  External  Ear  Infection” ; 
J.  0.  Hall,  D.  D.  S.,  on  “Oral  Health”,  and 
F.  W.  Carruthers  on  “Fractures.” 

<$> 

Personal  and  News  Items 


Ground  was  broken  on  July  30th  for  the 
new  medical  school  building  which  will  be 
erected  just  south  of  the  City  Hospital  in 
Little  Rock.  J.  K.  Sheperd,  president  of 
the  Chamber  of  Commerce,  presided,  and 
the  first  shovels  of  dirt  were  lifted  by 
Marion  Wasson,  Fred  I.  Brown  and  Alex- 
ander Allaire.  The  spade  used  will  be 
placed  in  a cabinet  in  the  lobby  of  the 
new  building.  Addresses  were  made  by 
Dr.  Vinsonhaler,  Marion  Wasson  and 
Grover  T.  Owens.  The  erection  of  the 
new  building  climaxes  more  than  thirty 
years  of  effort  on  the  part  of  the  school 
to  obtain  a proper  building  for  its  activi- 
ties.   

The  July  issue  of  the  Southern  Medical 
Journal  contains  “Malaria  Control  in  Ar- 
kansas, 1933,”  by  W.  B.  Grayson,  and 
“Experimental  Production  of  Gastric  Ul- 
cers in  the  Albino  Rat  as  a Result  of  Vi- 
tamin G Deficiency,”  by  Harvey  Thatcher 
(with  Barnett  Sure).  The  Tri-State  Medi- 
cal Journal  for  July  contains  “Intraven- 
ous Medication — a Consideration  of  Some 
of  the  Drugs  Used  Today,”  by  Daniel  R. 
Hardeman,  Little  Rock. 

Geo.  F.  Jackson  and  W.  F.  Smith  have 
been  elected  1st  vice-president  and  direc- 
tor, respectively,  of  the  Little  Rock  Boy’s 
Club. 

M.  E.  McCaskill,  President-elect,  is  the 
subject  of  a laudatory  article  in  the  July 
issue  of  The  Mississippi  Doctor. 

W.  R.  Brooksher  has  been  appointed  a 
member  of  the  publication  committee  of 
the  American  Radium  Society. 

MARRIED — J.  D.  Riley,  superintend- 
ent, Arkansas  Tuberculosis  Sanatorium, 
and  Miss  Louise  Stevenson,  at  Booneville, 
on  August  9th.  The  Journal  offers  con- 
gratulations. 


Announcement  has  been  received  of  the 
marriage  of  Dr.  Laman  A.  Gray,  son  of 
Dr.  and  Mrs.  Frank  A.  Gray,  of  Batesville, 
to  Miss  Alice  Virginia  Crothers  on  June 
4,  1934.  Dr.  Gray  is  a member  of  the 
house  staff  of  Johns  Hopkins  Hospital. 

H.  H.  Smiley,  Texarkana,  has  been  ap- 
pointed district  deputy  grand  exalted  rul- 
er of  the  B.  P.  0.  E.  for  the  western  dis- 
trict of  Arkansas. 


R.  R.  Kirkpatrick  and  W.  Decker  Smith 
were  recently  elected  commander  and 
executive  committeeman  respectively  of 
the  Texarkana  Post  of  the  American  Le- 
gion. 

J.  J.  Willingham,  State  Sanatorium,  di- 
rected a tuberculosis  clinic  and  spoke  to 

the  Lions  Club  at  Van  Buren  on  August  8. 

• <*> 

THE  AMERICAN  COLLEGE  OF  PHYSICIANS 
WILL  MEET  IN  PHILADELPHIA,  1935. 

The  American  College  of  Physicians  will  hold 
its  Nineteenth  Annual  Clinical  Session  in  Phila- 
delphia, April  29-May  3,  1935. 

Announcement  of  these  dates  is  made  particu- 
larly with  a view  not  only  of  apprising  physi- 
cians generally  of  the  meeting,  but  also  to  pre- 
vent conflicting  dates  with  other  societies  that 
are  now  arranging  their  1935  meetings. 

Dr.  Jonathan  C.  Meakins,  of  Montreal,  Que., 
is  President  of  the  American  College  of  Physi- 
cians, and  will  arrange  the  Program  of  General 
Sessions.  Dr.  Alfred  Stengel,  Vice  President  in 
Charge  of  Medical  Affairs  of  the  University  of 
Pennsylvania,  has  been  appointed  General  Chair- 
man of  local  arrangements,  and  will  be  in  charge 
of  the  Program  of  Clinics.  Mr.  E.  R.  Loveland, 
Executive  Secretary,  133-135  S.  36th  Street,  Phil- 
adelphia, Pa.,  is  in  charge  of  general  and  business 
arrangements,  and  may  be  addressed  concerning 
any  feature  of  the  forthcoming  session. 

€> 

“Biologically,  medically,  socially  and  culturally, 
the  eye  is  of  prime  importance  and  most  signifi- 
cantly useful,”  Dr.  Hyman  Cohen  says  in  the  in- 
troduction to  “The  Eye  Book,”  the  first  chapter 
of  which  appears  in  the  August  Hygeia.  Dr. 
Cohen  continues  by  saying,  “And  no  wonder,  for 
its  [the  eye’s]  parent  is  the  sun  himself.  There, 
above,  is  the  sun,  which  has  poured  its  light  down 
on  the  earth  ever  since  these  two  have  traveled 
the  spaces.  It  hatched  all  living  things;  it  made 
their  surfaces  sensitive  and  responsive  to  im- 
pinging rays.  When  the  first  lowly  creatures 
needed  sight,  the  sun,  by  its  insistence,  generat- 
ed the  eye.  Never  since  have  the  creatures,  high 
and  low,  thus  outfitted  and  adorned,  ceased  to 
worship,  each  in  its  own  way  and  measure,  the 
source  that  gave  them  eyes  with  which  to  see; 
nor  has  mankind  ceased  to  marvel  at  the  spec- 
tacle before  it  and  to  be  thankful  for  the  greatest 
of  all  gifts,  sight.” 


September,  1934]  ARKANSAS  MEDICAL  SOCIETY 


69 


Book  Reviews 


The  Medical  Profession  and  the  Public.  A 
publication  of  the  College  of  Physicians  of  Phila- 
delphia. Joint  Meeting  of  The  College  of  Physi- 
cians and  the  American  Academy  of  Political  and 
Social  Science,  February  7,  1934.  Pp.  112.  Price 
$1.00.  Printed  for  the  College,  Philadelphia, 
1934. 

This  volume  contains  the  addresses  presented 
at  a joint  meeting  of  the  College  of  Physicians 
of  Philadelphia  with  the  American  Academy  of 
Political  and  Social  Science  and  is  of  utmost  im- 
portance to  the  individual  physician  inasmuch 
as  the  ten  addresses  discuss  the  problem  of  so- 
cialized medicine.  The  viewpoints  of  the  Milbank 
Memorial  Fund  and  the  Julius  Rosenwald  Fund, 
who  advocate  the  adoption  of  a socialized  scheme 
of  medical  practice,  are  presented.  It  is  obvious 
that  the  weight  of  this  program  was  thrown  to 
the  side  of  the  proponents  of  socialized  medi- 
cine; Morris  Fishbein  alone  representing  organ- 
ized medicine  and  speaking  for  the  individual 
practitioner  of  medicine.  In  all  fairness  we  be- 
lieve that  he  has  well  supported  the  contentions 
of  organized  medicine  against  considerable  odds. 


Passional  Psychology.  By  Dr.  Jacobus  X. 
Privately  printed.  Pp.  405.  Price  $4.00.  New 
York:  The  American  Anthropological  Society, 
1934. 

This  volume  deals  with  the  study  of  the  physi- 
ology and  psychology  of  the  sexual  life  and  com- 
pares the  distinguishing  features  of  the  psychol- 
ogy of  love  in  the  male  and  the  female.  For  the 
purpose  of  this  study  the  development  of  the 
sexual  instinct  is  traced  from  lower  forms  of 
mammalian  life  to  the  human  being.  The  work 
is  of  particular  interest  to  students  of  psychology 
and  psychiatry. 


Manual  of  Diseases  of  the  Eye.  By  Charles 
H.  May,  M.  D.,  Director  and  attending  surgeon, 
eye  service,  Bellevue  Hospital,  New  York,  1916 
to  1927.  Consulting  opthalmologist  to  the  Mount 
Sinai  Hospital,  to  the  French  Hospital,  etc.  Four- 
teenth edition,  revised.  Price  $4.00.  Pp.  478. 
Baltimore:  William  Wood  and  Co.,  1934. 

The  fourteenth  edition  of  this  well  known  and 
justly  popular  book  lives  up  to  the  standard  that 
has  justified  thirteen  previous  editions  with 
many  reprints.  As  a manual  for  the  student  and 
general  practitioner  it  covers  the  subject  in  a 
comprehensive  yet  brief  manner  and  is  a volume 
of  convenient  size. 

After  three  chapters  devoted  to  methods  of 
examination,  the  component  parts  of  the  eye  are 
taken  up  and  presented  so  that  the  separate 
parts  may  be  made  most  clear.  Each  chapter 
presents  concisely  the  anatomy,  the  diseases  of 
the  part,  relation  to  other  parts,  pathology  and 
treatment.  Treatment, — that  which  most  inter- 
ests the  general  practitioner, . — is  well  presented, 
and  the  remedies  and  measures  advised  are  most 
sound. 

The  colored  plates,  which  are  especially  use- 
ful in  presenting  certain  phases  of  this  subject, 
deserve  special  mention.  There  are  twenty-five 


such  plates  with  78  colored  figures  which  have 
been  selected  with  care  as  to  present  typical 
and  common  conditions  and  have  been  repro- 
duced for  the  most  part  with  great  accuracy. 
The  novice  in  opththalmoscopy,  for  example,  could 
by  consulting  the  plates  easily  differentiate  a 
given  case  of  optic  atrophy  into  primary  or  sec- 
ondary. 

As  the  author  states  it  is  not  recommended  as 
a substitute  for  the  larger  works  on  Ophthal- 
mology yet  it  gives  the  fundamental  and  essen- 
tial facts  on  the  subject  and  the  commoner  dis- 
eases and  conditions  are  described  with  compara- 
tive fullness. — R.  J.  C. 


The  Spastic  Child.  By  Marguerite  K.  Fischel. 
Pp.  97.  Price  $1.50.  Saint  Louis:  C.  Y.  Mosby 
Co.,  1934. 

Being  deeply  interested  in  pediatrics,  “The 
Spastic  Child”  held  a strong  appeal  for  me.  A 
small  volume  of  97  pages,  it  is  a thunderous  re- 
buttal to  the  “hopeless”  or  “nothing  can  be  done” 
opinions,  all  too  frequently  pronounced  by  men 
of  medicine.  Little’s  disease,  or  spastic  paraple- 
gia, is  the  subject;  Therapy,  in  its  various  phases, 
its  content;  Tragedy,  its  background;  Courage, 
its  motif;  and  Success,  its  ending.  It  is  a record 
of  only  one  child  but  offers  hope  to  many.  This 
is  a volume  well  worth  having  in  your  library. — 
J.  W.  A. 


Trademark  V I ^ Trademark 

Registered  1^^  X 9 M \ J.  T ffl  Registered 

Binder  and  Abdominal  Supporter 


Gives  perfect  up- 
lift. Is  worn  with 
comfort  and  satis- 
faction. Made  of 
Cotton,  Linen  and 
Silk;  washable  as 
underwear.  Three 
distinct  types  and 
many  variations 
of  each.  Belts  de- 
signed according 
to  needs  of  case. 


Picture  Shows  “Type  N” 

For  all  conditions,  as  Ptosis,  Hernia, 
Pregnancy,  Obesity,  Sacroilias  Relaxa- 
tions, High  and  Low  Operations,  etc. 

Each  Belt  Made  to  Order — Ask  lor  Literature 

KATHERINE  L.  STORM,  M.  D. 

Originator,  Owner  and  Maker 
1701  DIAMOND  ST.  PHILADELPHIA 


70 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  4 


Compend  of  Diseases  of  the  Skin.  By  Jay 
Frank  Schamberg,  A.  B.,  M.  D.,  Professor  of 
Dermatology  and  Syphiolology  Graduate  School 
of  Medicine,  University  of  Pennsylvania,  etc.,  and 
Carroll  S.  Wright,  B.  S.,  M.  D.,  Professor  of 
Dermatology  and  Syphilology  Temple  University 
School  of  Medicine,  etc.  Ninth  Edition.  Cloth. 
Price  $2.00.  Pp.  319.  Philadelphia:  P.  Blakis- 
ton’s  Son  and  Co.,  1934. 

This  edition  has  been  expanded  to  include  mod- 
ern treatment  of  syphilis,  lymphogranulomatosis 
cutis  and  granuloma  inguinale.  This  compend 
may  be  approved  as  one  of  the  most  useful  guides 
to  dermatology  thus  far  available.  The  book  is 
printed  on  thin  paper  in  easily  readable  type. 
Altogether,  it  supplies  a vast  amount  of  exceed- 
ingly useful  and  practical  data  at  a low  price. 
It  is  a book  that  a physician  will  want  to  keep 
on  his  desk  and  to  carry  about  with  him  in  his 
handbag. — G.  F.  J. 


Surgical  Clinics  of  North  America.  (Mayo 
Clinic  Volume — June,  1934).  Volume  14,  Num- 
ber 3.  221  pages  with  70  illustrations.  Per  Clinic 
Year,  published  bi-monthly,  paper  $12.00,  cloth 
$16.00.  Philadelphia,  W.  B.  Saunders  Co.,  1934. 

All  Mayo  Clinic  articles,  cases,  reviews  and 
volumes  are  extremely  interesting  and  set  a high 
example  of  medical  writings  for  the  profession. 
We  expect  and  do  find,  a large  number  of  in- 
teresting and  rare  conditions  that  would  come 
under  their  observation.  An  interesting  report  is 
one  of  malaria  developing  following  an  operation, 
a condition  frequently  seen  in  the  South.  We 
find  Judd  stating  that  gastro-enterostomy  has 
given  satisfactory  results  in  about  90  per  cent  of 
all  cases  in  which  it  was  the  most  logical  pro- 
cedure and  in  which  it  was  properly  performed. 
This  a higher  percentage  than  other  surgeons 
report  and  so  adds  more  fuel  to  the  ever  increas- 
ing argument  concerning  ulcer  cases.  A unique 
method  of  improving  the  abdominal  wall  in  cases 
of  fistula  and  also  testing  the  potency  of  the 
intestine  is  by  plugging  the  external  fistula  open- 
ing with  chewing  gum,  which  the  patient  has 
previously  chewed  to  the  requisite  softness.  This 
method  was  originated  by  the  late  Donald  Macrae, 
Jr.  of  Council  Bluffs,  Iowa. — I.  F.  J. 


ANNUAL  FALL  CLINICAL  CONFERENCE 
OF  THE  KANSAS  CITY  SOUTHWEST 
CLINICAL  SOCIETY 


The  August  Bulletin  of  the  Kansas  City  South- 
west Clinical  Society  is  the  Broadside  announc- 
ing the  program  of  the  Annual  Fall  Clinical  Con- 
ference, October  first  through  fourth. 

This  is  the  twelfth  consecutive  year  of  the 
clinical  conferences  presented  each  October  in 
Kansas  City,  Missouri.  If  you  have  not  received 
a copy  of  this  Broadside,  one  is  available  for 
you  in  the  Executive  Office  of  the  Society,  207 
Shukert  Building,  Kansas  City,  Missouri. 

Forty  lectures  will  be  presented  before  the 
General  Assemblies  by  twelve  guest  speakers  and 
twenty  members  of  the  society  during  the  morn- 
ing, afternoon  and  one  evening  session.  Sub- 
jects of  these  addresses  will  pertain  to  interest- 
ing features  of  medicine,  surgery  and  the  spe- 
cialties. 

Addresses  appropriate  for  the  lay  public  as 
well  as  the  medical  profession  will  be  delivered 
by  three  guest  speakers  on  Monday  night  before 
the  public  meeting. 

Two  addresses  will  be  presented  by  guest 
speakers  before  the  Tuesday  evening  joint  meet- 
ing with  the  local  medical  societies. 

Two  short  addresses  will  also  be  made  daily 
at  the  close  of  the  round  table  luncheons  by  guest 
speakers. 

Wednesday  evening  will  be  devoted  to  enter- 
tainment for  the  attending  physicians  and  their 
families. 

The  scientific  exhibits  will  be  on  display  in 
the  Congress  room  of  the  Hotel  President  during 
the  entire  conference.  These  exhibits  will  con- 
sist of  photographs,  micro-photographs,  X-rays, 
pathological  specimens,  etc.,  on  tuberculosis,  ar- 
teriography, hypospadias,  foreign  bodies,  tumors, 
cancers,  as  well  as  clinical  applications  and  dem- 
onstrations. 

The  completed  program  of  this  Fall  Confer- 
ence will  appear  in  the  September  issue  of  the 
Monthly  Bulletin  of  the  Kansas  City  Southwest 
Clinical  Society. 


Granite  Mountain  Hospital 

Open  to  All  Reputable  Physicians  and  Surgeons 

S.  P.  JUNKIN,  M.  D.,  Medical  Director 

Telephone  Rural  9579-F2  Route  4,  Little  Rock,  Ark. 

J.  L.  Harris  Roe  McCranie 

LITTLE  ROCK  ARTIFICIAL  LIMB  CO. 

The  Old  Reliable  Firm  LIMBS  AND  BRACES  Same  Location  Since  1911 
521  1-2  Main  Street  Phone  5979  Little  Rock,  Ark. 


THE  JOURNAL 

of  the  ARKANSAS  MEDICAL  SOCIETY 


PUBLISHED  MONTHLY  UNDER  DIRECTION  OF  THE  COUNCIL 


Vol.  XXXI 


Fort  Smith,  Arkansas,  October,  1934 


No.  5 


ALLERGY: AN  EVERYDAY 
PROBLEM 

W.  T.  Wootton,  M.  D. 

Hot  Springs  National  Park 


To  paraphrase  Osier : “Know  Allergy  in 
all  of  its  manifestations  and  you  will 
know  all  diseases.” 

As  long  as  we  have  been  seeing  urtica- 
ria, hay  fever,  asthma  and  other  evidences 
of  the  wide  variation  that  angio-neurotic 
edema  may  assume  it  is  a little  surprising 
that  we  ordinary,  every-day  practitioners 
have  been  so  slow  to  accord  allergy  its 
rightful  place  as  an  imitator  of  various 
and  sundry  other  conditions  and  as  a med- 
dler with  symptoms  .in  general.  Instead, 
we  have  left  it  in  the  hands  of  the  hay 
fever  specialist. 

That  allergy  ranks  as  one  of  the  fore- 
most considerations  in  making  a diagnosis 
in  most  of  our  every-day  routine  work  can- 
not be  successfully  denied.  Whenever  a 
case  is  not  absolutely  conclusive  in  its 
symptomatology;  if  laboratory  and  physi- 
cal findings  do  not  completely  check;  al- 
lergy should  be  considered  and  ruled  out 
prior  to  further  procedure.  Very  few  dif- 
ferential diagnoses  are  complete  without 
due  consideration  of  an  allergic  influence. 

I shall  recite  a few  examples  of  its  wide- 
ly diversified  nature  in  an  attempt  to  show 
the  practical,  every-day  necessity  for  keep- 
ing allergy  constantly  in  mind  when  see- 
ing your  usual  run  of  patients.  It  is  my 
sole  aim  to  strongly  emphasize  this  neces- 
sity and  in  so  doing  I hope  that  my  past 
failure  to  realize  that  allergy  is  not  a con- 
dition to  be  relegated  to  the  specialist  but 
one  to  be  dealt  with  in  an  every-day  man- 
ner may  keep  someone  else  from  falling 
into  that  same  error.  As  I see  it,  allergy 
is  to  be  suspected  in  all  unusual  cases. 
Generalizing  I should  say  that  allergic 


*Read  before  the  Fifty-ninth  Annual  Session 
of  the  Arkansas  Medical  Society  held  in  Little 
Rock,  April  16-18,  1934. 


tests  will  more  often  give  positive  in- 
formation in  routine  studies  than  will 
basal  metabolism,  blood  chemistry  or  Was- 
serman  tests. 

Whenever  a family  or  personal  history 
reveals  asthma,  hay  fever  or  urticaria  one 
should  most  certainly  be  on  guard. 

When  a patient  presents  himself  at  your 
office  and  states  he  has  tried  all  the  skin 
specialists  he  has  heard  of  and  has  not 
been  relieved,  it  is  not  enough  for  you  to 
say  he  has  probably  been  eating  something 
unsuited  to  him.  It  is  up  to  you  to  deter- 
mine what  food  is  poison  to  that  particu- 
lar individual,  as  this  may  relieve  his 
symptoms. 

It  might  be  well  to  also  keep  allergy  in 
mind  when  reviewing  that  case  which  ex- 
haustive medical  or  surgical  attention  has 
failed  to  completely  relieve.  Do  not  be 
content  to  hope  that  time  will  in  some  way 
overcome  symptoms  too  obscure  for  you  to 
cope  with.  At  least  eliminate  any  chance 
that  you  may  be  dealing  with  allergy  be- 
fore setting  that  patient  adrift. 

Allergy  is  a very  definite  condition 
subject  to  very  practical  application  in 
diagnosis  and  treatment.  Its  simulation 
of  so  many  well-defined  diseases  is  apt  to 
mislead  us  and  keep  its  importance  under- 
emphasized. 

Case  1.  Male,  age  62.  Luetic  history  extend- 
ing back  40  years.  Treatment  had  been  quite 
sketchy  or  inadequate.  Chief  complaint,  shooting 
pains  in  both  legs.  Worse  some  weeks  than  oth- 
ers with  periods  of  freedom  as  long  as  two 
months.  Blood  and  spinal  fluid  serology  entirely 
negative,  cell  count  normal.  Neurological  tests 
failed  to  locate  a lesion.  Other  than  the  re- 
current  lancinating  pains,  this  man’s  general 
health  seemed  exceptionally  good.  He  came  to 
Hot  Springs  believing  his  old  boyhood  trouble 
was  in  some  way  at  the  bottom  of  his  discomfort. 
It  was  not  hard  to  agree  with  him  that  such  a 
possibility  was  tenable  though  all  physical  and 
laboratory  findings  denied  such  a condition.  He 
underwent  a very  thorough  course  of  antileutic 
treatment  without  abatement  of  symptoms.  He 
was  reminded  that  the  river  runs  muddy  for 
sometime  after  the  rains  cease. 

This  man  returned  a year  later  without  change 


72 


THE  JOURNAL  OF  TH  E 


[Vol.  XXXI,  No.  5 


in  symptoms.  The  river  was  still  muddy.  In 
considering  other  causes  for  the  persistent  symp- 
toms, allergy  seemed  a remote  possibility  but 
nevertheless  he  was  put  through  the  tests  which 
revealed  that  he  was  sensitive  to  practically  all 
sea  foods  and  many  fruits.  Correcting  his  diet 
has  relieved  his  pains  for  over  two  years. 

Case  II.  A woman,  age  42,  who  had  been  a 
sufferer  from  migraine  for  at  least  15  years.  In 
this  instance  allergy  was  the  first  causative  agent 
suspected,  although  one  of  the  best  hospital  clinics 
in  the  East  had  centered  on  a bacterial  origin, 
resulting  in  innumerable  sinus  drainages  without 
relief  of  symptoms. 

Her  attacks  were  so  severe  that  her  physician 
wrote  that  a half-grain  dosage  of  morphia  would 
be  required  at  frequent  intervals  to  produce  any 
semblance  of  ease  during  an  attack.  This  I had 
ample  opportunity  to  verify. 

She  was  found  sensitive  to  twelve  articles  of 
food  in  her  regular  diet  and  also  house  dust.  Cor- 
rection of  the  latter  was  a problem,  but  oil  mop- 
ping instead  of  sweeping  practically  answered  the 
question.  As  long  as  she  could  or  would  stick 
strictly  to  her  diet  she  would  be  free  of  migraine, 
but  should  she  relax  this  vigilance  through  the 
misadventure  of  dining  out  and  partake  of  a 
salad,  vegetable,  soup,  croquette,  hash  or  other 
food  combination  of  unknown  origin  she  would 
pay  the  price  within  24  hours. 

Case  III.  Young  married  woman,  age  24,  would 
suddenly  be  overwhelmed  by  a desire  to  vomit 
with  little  or  no  preceding  nausea.  Of  course 
pregnancy  was  suspected  though  unsupported  by 
other  symptoms.  When  definitely  ruled  out  as 
the  cause,  allergic  tests  reevaled  the  excitant 
agents  as  unaccustomed  articles  of  food  being 
consumed  in  an  effort  to  conform  with  her  hus- 
band’s household.  Of  course  the  neurotic  element 
entered  into  the  picture  as  “Particeps  Criminis.” 

Case  IV.  A woman,  age  28,  wanted  to  take 
baths  on  general  principles — which  may  also  be 
a good  reason  for  bathing.  A herpetic  and  ma- 
culo-papular  eruption  was  quite  evident,  marring 
an  otherwise  skin  “you  would  love  to  touch.”  She 
said  she  considered  her  blemishes  a part  of  “The 
Curse”  as  they  were  always  worse  at  her 
“periods”  but  never  quite  left  between  times.  She 
remarked  that  she  had  become  resigned  to  her 
fate  having  used  a carload  of  ointments  without 
encouraging  improvement  and  now  no  longer 
tried  to  do  anything  to  cure  it. 

It  was  quite  difficult  to  sell  her  on  the  allergic 
idea.  However,  since  a very  inconsequential 
change  in  her  diet  removed  all  outward  evidence 
of  “The  Curse,”  she  is  trying  to  sell  the  idea  to 
every  pimply-faced  young  matron  she  knows. 

Case  V.  An  active,  alert  gentleman  of  71 
years  could  not  dress  himself  due  to  so-called 
arthritis  of  several  years  standing.  His  pain 
was  in  his  shoulders  and  elbows  mostly,  and  in 
the  knees  and  hips  moderately.  The  vibration 
of  the  wheel  in  trying  to  drive  his  car  caused 
agony.  X-rays  of  the  joints  disclosed  no  bony  or 
ligamentous  change.  Diligent  search  in  several 


of  the  best  clinics  in  the  North  failed  to  reveal 
an  infected  focus  that  might  be  accused. 

This  man  came  out  of  a prominent  sanatorium 
on  a diet  of  milk,  cheese,  eggs,  nuts,  oranges  and 
vegetables.  I claim  that  is  a good  diet  in  any 
man’s  country,  but  it  was  rank  poison  to  this 
one  individual.  He  was  four  plus  positive  to  the 
first  five  named  articles  and  variously  sensitive 
to  more  than  fifty  common  articles  of  food.  Elimi- 
nating these  there  remained  a neat  little  prob- 
lem in  finding  something  for  him  to  live  on. 
After  completely  revolutionizing  his  epicurean 
existence,  he  became  again  comfortable,  can 
dress  himself  and  writes  that  he  drives  his  car 
daily  and  is  actively  at  his  work  as  manager  of 
a telephone  corporation. 

Case  VI.  This  lady  came  in  saying  she  only 
wanted  bathing  directions  as  she  had  already  been 
through  several  clinics  and  they  could  find  no 
infection  to  account  for  the  neuritis  in  her  arm. 
She  inadvertently  made  some  mention  of  her  hay 
fever,  which  was  a wonderful  opening  wedge  in 
the  matter  of  other  allergic  possibilities.  Scratch 
tests  in  this  instance  revealed  in  food  that  which 
had  been  sought  in  tonsils  and  cervix. 

A peculiar  feature  of  this  case,  at  least  it  so 
seemed  to  me,  was  that  she  had  been  treated 
seasonally  in  a hay  fever  clinic  for  several  years 
and  was  thoroughly  posted  on  pollens,  yet  had 
never  had  any  tests  for  'foods. 

Case  VII.  A neurotic  young  matron,  age  31, 
would  have  peculiar  sensations  or  feelings  after 
eating.  She  would  become  so  irritable  that  at 
times  she  would  almost  lose  self-control.  As  she 
expressed  it  “she  would  feel  and  act  as  mean  as 
the  devil.”  Breakfast  was  alright,  but  lunch  and 
dinner  almost  invariably  brought  on  tantrums. 
She  said  a number  of  surgeons  had  suggested  ex- 
ploratory abdominal  operation  as  a means  of  de- 
termining the  cause  of  her  gastric  and  abdominal 
distress. 

Believe  it  or  not,  her  disposition  underwent  a 
complete  though  slow  metamorphosis  as  the  al- 
lergic foods  were  removed  from  her  diet. 

Case  VIII.  A lady  nearing  the  eighties  in 
years  and  225  pounds  in  weight  came  in  all  hot 
and  bothered  because  she  could  not  rise  from  a 
sitting  posture  with  ease  or  walk  off  until  she 
stood  for  a few  seconds  to  get  the  kinks  out  of 
her  knees.  In  spite  of  the  acknowledged  age  and 
evident  weight,  this  lady  was  in  all  respects,  de- 
sires and  actions  as  young  as  if  only  half  that 
age.  X-ray  again  failed  to  reveal  any  change 
in  or  around  the  joints.  There  was  considerable 
swelling,  however. 

Years  ago  she  had  been  told  to  forego  all  red 
meats  and  substitute  fish  and  fowl.  Scratch  tests 
showed  that  she  was  not  in  the  least  sensitive  to 
any  one  of  the  red  meats  or  bacteria  but  was  four 
plus  to  chicken,  duck,  turkey  and  sea  foods.  With- 
in ten  days  after  correcting  the  diet  to  conform 
with  her  allergic  tests  the  swelling  had  material- 
ly decreased.  There  was  less  impairment  in  mo- 
tion, which  has  remained  over  a period  of  several 
months.  She  is  not  completely  relieved  but  re- 
markably benefitted  considering  age  and  weight. 


October,  1934]  ARKANSAS  MEDICAL  SOCIETY 


73 


Case  IX.  A heavy-set  gentleman  who  looked 
the  picture  of  health  and  a lover  of  the  “flesh 
pots,”  complained  of  recurrent  gout  in  both  great) 
toes.  This  man  had  been  for  several  years  in  a 
country  where  highly  seasoned  foods  predominate. 
He  had  been  warned  against  alcohol  and  red 
meats  as  the  probable  source  of  his  gout.  There 
were  no  tophi.  Allergic  tests  showed  that  he  was 
strongly  sensitive  to  condiments — mustard,  pap- 
rika, red  and  black  peppers  and  sage.  He  was 
also  four  plus  to  chicken,  clams,  oysters,  lobster 
and  shrimp.  He  was  not.  sensitive  to  any  of  the 
red  meats. 

It  was  joyous  news  to  this  man  that  he  could 
again  have  his  beef  and  beer,  though  the  absti- 
nence from  highly  seasoned  foods  was  a real  de- 
privation. However,  when  he  found  that  by  leav- 
ing them  off  he  could  get  his  shoes  on,  he  no 
longer  argued  the  point. 

Case  X.  A young  man,  aged  36,  with  a general 
progressing  scleroderma  had  had  bacteria  as  the 
sole  causative  agent  preached  to  him  at  a promi- 
nent clinic.  He  was  treated  with  typhoid  pro- 
tein therapy  without  checking  the  onward  pro- 
gress of  the  disease.  No  focus  of  infection  could 
be  found. 

He  was  found  insensitive  to  bacteria  but  sen- 
sitive to  a number  of  foods  and  emanations.  He 
received  absolutely  no  treatment  other  than  the 
Hot  Springs  baths  and  a diet  according  with  his 
sensitivity.  At  the  end  of  the  first  week  after 
this  correction  it  was  noted  that  there  was  no 
further  progression,  the  first,  check  in  nine 
months.  After  the  third  week  adrenalin  was  ad- 
ministered; intramuscularly  at  first,  later  by 
mouth.  There  has  been  a slow  recession  of  the 
board-like  areas  for  the  past  three  months.  This 
patient  is  still  under  observation. 

Case  XII.  This  case  exempliifes  the  error  of 
omission  rather  than  commission.  He  came  to 
me  with  a letter  outlining  his  blood  count,  micro- 
scopic and  chemical  urinalysis,  gastric  analy- 
sis, blood  sugar  determination,  urea  nitrogen,  uric 
acid  content,  blood  serum  calcium,  basal  meta- 
bolic rate,  Wasserman  tests  of  blood  serum  and 
spinal  fluid,  X-ray  of  gall  bladder  after  dye,  stom- 
ach and  duodenal  findings,  X-ray  of  spine  and 
other  articulations. 

This  man  has  an  arthritis  of  the  lumbar  spine, 
but  the  symptoms  that  annoy  him  and  prevent 
him  from  attending  to  his  business  are  referable 
to  his  abdominal  tract,  and  directly  related  to 
the  intake  of  food.  His  lips,  hands  and  feet  swell 
without  apparent  reason.  He  becomes  extremely 
nervous,  fidgety,  and  the  more  he  fidgets  the  more 
he  smokes. 

No  allergic  tests  had  even  been  considered  for 
this  man  during  a very  intensive  study  of  his 
case.  Yet  he  is  sensitive  to  a long  list  of  foods 
and  is  one  of  the  few  who  is  quite  sensitive  to 
tobacco. 

In  conclusion  I think  that  you  and  I 
might  profitably  resolve  that  we  will 
never  send  another  patient  to  the  operat- 


ing table  suffering  with  recurrent  appen- 
dix attacks,  peptic  ulcer,  gall  bladder  dis- 
ease, renal  colic  or  sinus  trouble  without 
first  knowing  that  patient’s  allergic  re- 
action. 

I think  we  might  go  further  and  resolve 
to  give  all  those  rheumatic  cases,  especial- 
ly those  of  hydrarthrosis  which  have  had 
teeth,  tonsils,  gall  bladder,  cervix  and 
other  extirpations  without  relief  from 
their  rheumatic  pains,  the  benefit  of  the 
doubt  and  test  them  for  allergy. 

Allergy  is  the  mask  worn  at  Diseases’ 
Fancy  Dress  Ball.  If  you  would  know  the 
guest,  remove  the  mask. 

DISCUSSION 

ALAN  G.  CAZORT,  Little  Rock:  I am  glad 

to  see  this  paper  come  from  an  internist.  The 
chief  interest  in  the  paper  to  me  lies  in  the  wide 
variety  of  symptoms  which  it  has  covered.  As 
Dr.  Wootton  is  a man  of  wide  experience,  we  can 
not  say  that  here  is  just  another  allergist  taking 
his  exercise  by  jumping  at  conclusions.  As  soon 
as  we  can  cease  to  think  of  an  allergic  individual 
as  a case  of  hay  fever  or  asthma,  and  think  of 
him  as  a person  who  may  have  symptoms  which 
we  might  expect  to  find  from  a swelling  of  the 
tissues  of  the  body,  particularly  the  epithelial 
tissues,  we  will  then  be  in  a better  position  to 
weigh  the  allergic  factors  in  terms  of  the  patient’s 
complaints.  The  allergic  reaction  is  a swelling. 
It  may  be  anything  from  a slight  weal  on  the 
skin  to  the  involvement  of  whole  systems.  If  it 
is  in  the  skin,  we  call  it  urticaria;  if  in  the  nose, 
we  call  it  hay  fever;  if  in  the  bronchial  tract,  we 
call  it  asthma;  if  in  the  intestinal  tract,  we  call 
it,  “What  have  you?”  Now,  the  severity  of  the 
symptoms  may  also,  of  course,  be  in  any  degree, 
and  it  is  not  at  all  unreasonable  to  me  to  see  a 
wide  variety  of  symptoms  due  to  allergy  or  a lot 
of  things  the  doctor  mentioned  which  I haven’t 
run  into,  at  least,  as  primary  complaints.  I was 
interested  in  talking  to  him  about  this  thing  not 
very  long  ago.  I just  want  to  say  that  if  the 
symptoms  that  the  patient  has  could  be  due  to 
swelling;  if  no  other  cause  for  the  symptoms  can 
be  found,  particularly  if  there  is  a suggestive 
family  or  personal  history;  then  I think  allergy 
is,  at  least,  to  be  considered. 

I envy  Dr.  Wootton’s  location  at  Hot  Springs, 
where  he  can  have  a wide  variety  of  chronic,  in- 
curable idiopathic  diseases  to  study,  and  I hope 
this  paper  will  stimulate  further  interest  in  that 
class  of  diseases  because  they  are  most  interest- 
ing. 

D.  W.  GOLDSTEIN,  Fort  Smith:  Dr.  Woot- 
ton touched  on  some  of  the  points  in  my  specialty, 
which  is  that  of  dermatology.  Dr.  Wootton’s 
paper  was  well  presented,  and  his  cases  were 
worked  up.  I wish  to  call  attention  to  the  thought 
of  allergy  in  dermatology.  First,  you  should 
take  a complete  history  and  often  the  history  will 


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[Vol.  XXXI,  No.  5 


lead  you  to  suspect  an  allergic  condition,  if  pres- 
ent. But,  first  of  all,  you  should  make  your  der- 
matological diagnosis  before  you  put  a patient 
through  a series  of  allergic  tests. 

I was  very  glad  to  have  the  doctor  bring  out 
the  thought  of  a neurological  disturbance  in  one 
case  of  his  which,  I think,  was  an  angioneurotic 
edema,  where  he  made  his  allergic  tests  and 
found  positive  signs.  As  to  these  angioneurotic 
edema  cases,  they  come  to  you  the  next  morning 
after  extreme  swelling  during  the  night  and  tell 
you  that  they  had  fish,  strawberries  or  some- 
thing of  the  kind  for  dinner.  They  have  diagnosed 
their  case  before  consulting  you.  These  chronic 
cases  of  angioneurotic  edema  are  a source  of 
trouble  to  all  of  us.  After  you  go  through  with 
your  food  tests,  you  frequently  fail  to  reach  a 
conclusion. 

I wish  to  call  your  attention  to  one  cause  that 
will  help  you  to  clear  up  your  cases,  and  that  is 
neurovascular  instability.  There  may  be  some- 
thing in  the  home  life  of  the  individual  which 
causes  this  flare-up  and  edema  of  the  skin.  An- 
other cause  is  chronic  infection  of  the  gall  blad- 
der, often  cleared  up  by  a gall  bladder  drainage. 

DR.  A.  S.  BUCHANAN,  Prescott,  Arkansas: 
Dr.  Wootton’s  paper  impressed  me  very  much  in 
that  the  subject,  as  presented,  touched  so  many 
specialties  in  medicine.  Even  surgery  came  along 
for  its  share  of  errors  in  diagnosis.  Dr.  Cazort 
mentioned  the  different  types,  locations  and 
causes  for  allergic  conditions,  which  may  effect 
the  patient  and  there  were  so  many  of  these  that 
I am  wondering  if  some  of  our  mistaken  diag- 
nosis are  not  due  to  allergy,  even  in  our  surgical 
cases.  In  this  connection,  and  to  substantiate  Dr. 
Wootton’s  contention  that  allergy  plays  an  im- 
portant role,  I should  like  to  mention  one  case. 

A young  married  man  of  thirty  came  to  me 
complaining  of  a transient  eruption  of  the  skin 
of  the  right  side  of  the  face.  He  was  a traveling 
man  and  was  away  from  home  about  half  of  the 
time.  The  condition  would  clear  up  when  away 
from  home  but  upon  his  return  it  would  recur. 
After  exhausting  all  my  efforts  and  after  he 
had  consulted  several  of  the  best  dermatologists 
of  the  state,  we  discovered  that  the  cause  of  his 
trouble  was  hair  dye  used  by  his  wife.  Since  she 
discontinued  the  use  of  this  cosmetic  the  man  has 
had  no  return  of  his  face  eruption. 

Dr.  Wootton’s  paper  was  very  instructive  and 
I am  glad  to  have  had  the  opportunity  of  hear- 
ing it. 

DR.  WOOTTON,  in  response:  Gentlemen,  I 

merely  want  to  plead  guilty  to  having  picked  out 
the  most  successful  cases  I could  find  on  my 
case  records.  Do  not  believe  that  you  are  going 
to  make  a few  scratches  and  have  a relieved  pa- 
tient, because  some  of  them  are  certainly  going 
to  be  problems.  And,  although  you  may  find 
them  sensitive  to  certain  articles  of  food,  it  isn’t 
always  a simple  matter  of  cutting  out  a few  arti- 
cles here  and  there  and  curing  the  patient.  It  is 
a hard  struggle,  especially  in  the  chronic  cases. 


CHILDHOOD  TUBERCULOSIS* 
A.  A.  Blair,  M.  D.,  F.  A.  C.  P. 
Fort  Smith 


In  order  to  make  a practical  attack  upon 
the  dissemination  of  tuberculosis,  we 
should  start  in  early  life  to  protect  our 
youngsters  from  the  ravages  of  this  dis- 
ease by  applying  our  knowledge  of  cer- 
tain facts  pertaining  to  its  control. 

From  what  we  know  about  childhood 
tuberculosis,  the  “contact  child’s”  health 
is  always  endangered.  The  incidence  of 
infection  among  infants  varies  with  the 
opportunities  for  exposure.  Myers  (1) 
states  that  among  groups  with  no  known 
exposure  as  few  as  one  or  two  per  cent 
are  found  to  be  infected,  but  among  groups 
with  known  histories  of  exposure,  as  many 
as  fifty  to  seventy-five  per  cent  may  be- 
come infected.  If.  the  exposure  continues, 
even  one  hundred  per  cent  may  be  in- 
fected. 

We  speak  of  childhood  tuberculosis  as 
a disease  resulting  from  first  infection  in 
the  lung  from  the  tubercle  bacillus,  re- 
gardless of  age  in  life  when  it  develops. 
When  the  tubercle  bacillus  finds  lodge- 
ment in  the  lung  parenchyma,  an  area  of 
inflammation  is  set  up,  and  soon  the  tra- 
cheo-bronchial  lymph  nodes  are  involved. 
The  child’s  ability  to  cope  with  this  infec- 
tion determines  largely  what  happens  at 
this  stage.  Healing  may  readily  take 
place,  caseation  and  calcium  deposit  may 
shortly  be  found,  entirely  taking  in  this 
area  of  infection.  If  the  child’s  environ- 
ment is  poor  and  continued  exposure  is 
permitted,  the  outcome  may  be  disastrous. 
The  graphic  view  of  tuberculosis  mortal- 
ity by  age  shows  two  peaks ; one  for  those 
under  five,  the  other  after  age  ten.  Chad- 
wick’s (2)  figures  show  the  children  un- 
der five  a death  rate  of  32.9  per  cent; 
from  five  to  nine  it  drops  to  10.2  per  cent; 
from  ten  to  fourteen  16.1  per  cent;  from 
fifteen  to  nineteen  it  rises  to  71.8  per  cent. 
It  seems  during  the  second  five-year  period 
of  life  the  child  develops  some  immunity 
which  enables  him  to  resist  tuberculous 
infection  to  a considerable  extent. 

The  immediate  problem  of  supervision 


*Read  before  the  Fifty-ninth  Annual  Session 
of  the  Arkansas  Medical  Society  held  in  Little 
Rock,  April  16-18,  1934. 


October,  1934]  ARKANSAS  MEDICAL  SOCIETY 


75 


is  the  severity  and  length  of  infection  to 
which  any  infants  in  the  household  may 
have  been  exposed.  There  is  evidence 
that  even  young  infants  may  recover  from 
lesions  resulting  from  transitory  severe 
exposure,  or  slight  exposure  lasting  sev- 


Fig.  1 (upper) — E.  D.  Lung  abscess,  post-ton- 
sillectomy, with  gangrene  and  rupture  into  the 
left  pleural  cavity,  superimposed  upon  an  old 
calcified  childhood  tuberculosis.  Two  plus  posi- 
tive Mantoux,  C dilution. 

Fig.  2 (lower) — E.  J.  E.  female,  age  10.  Man- 
toux Dilution  B,  3 plus  positive.  Calcifications 
of  a previous  right  tracheo-bronehial  childhood 
tuberculosis,  with  signs  of  calcification  in  simi- 
lar areas  on  the  left. 


eral  weeks.  But  in  all  cases,  whether  the 
lesion  is  large  or  small,  even  it  be  in  the 
lung  or  lymph  nodes,  there  is  grave  danger 
of  a metastasis  or  dissemination  of  this 
infection  to  other  important  structures  of 
the  body,  particularly  the  meninges.  Pre- 
caution should  be  taken  to  prevent  re-in- 
fection  or  additional  infection  to  what 
may  exist,  and  to  keep  the  infant  in  the 
best  possible  living  conditions,  preferably 
in  the  mother’s  care,  provided  she  is  not 
the  source  of  its  infection  and  has  the 
time,  means  and  inclination  to  care  prop- 
erly for  it. 

Inasmuch  as  tuberculosis  is  largely  a 
contact  infection,  every  child  in  a house- 
hold where  a case  exists  should  be  rigidly 
examined  for  the  presence  of  this  disease 
and  thus  break  contact  at  the  earliest  pos- 
sible moment.  There  unquestionably 
exist  many,  many  cases  of  active  tubercu- 
losis among  school  children,  and  scarcely 
little  is  being  done  about  it,  except  in  a 
few  instances  over  widely  scattered  areas. 
I believe  the  state  of  Massachusetts  has 
led  the  country  in  the  investigation  of  tu- 
berculosis in  school  children,  and  while 
much  of  our  attention  is  centered  upon  the 
prevention  and  control  of  diphtheria,  ty- 
phoid, scarlet  fever,  measles,  etc.,  in  the 
schools,  our  health  authorities  are  giving 
little  consideration  to  the  detection  and 
isolation  of  tuberculosis  among  children 
of  school  age.  This  is  not  an  open  criti- 
cism of  health  agencies,  as  it  requires 
much  time,  equipment  and  expense  to 
carry  out  a program  of  this  kind,  and  many 
city  and  county  health  departments  are 
barely  existing  on  account  of  funds.  I 
certainly  want  to  urge  you  to  assist  the 
State  Tuberculosis  Association  in  every 
way  possible  to  further  this  work  in  every 
rural  and  city  school  of  the  state.  I dare 
say  the  average  physician  is  not  especially 
aroused  to  the  tremendous  prevalence  of 
juvenile  tuberculosis  and  necessity  for  its 
early  recognition  as  a health  measure. 

The  diagnosis  of  tuberculosis  in  chil- 
dren is  seldom  an  easy  matter.  When 
symptoms  are  present  in  childhood  they 
are  of  great  importance.  The  first  symp- 
tom may  consist  of  slight  fever,  loss  in 
weight,  loss  of  energy  and  play  spirit.  One 
must  never  be  misled  by  absence  of  symp- 
toms. Frequently  contact  children  are 
taken  to  a physician,  and  on  account  of 
absence  of  symptoms,  and  physical  find- 


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[Vol.  XXXI,  No.  5 


mgs,  the  parents  are  told  that  tuberculosis 
does  not  exist.  It  has  been  repeatedly 
found  and  proven  most  conclusively  that  a 
child  without  a suggestion  of  a symptom 
may  have  an  active  tuberculous  process  of 
a progressive  type. 

In  the  search  for  tuberculosis  in  chil- 
dren the  history  of  contact  is  the  first  pro- 
cedure, though  we  should  not  be  misled 
on  account  of  not  being  able  to  obtain  a 
positive  history  of  contact,  because  many 
cases  of  tuberculosis  in  family  adults  have 
not  been  recognized  and  reported.  So  a 
child  whose  health  status  appears  below 
par  with  no  ascertainable  cause  found, 
should  be  regarded  with  suspicion.  The 
second  method  of  procedure  in  diagnosis 
is  the  tuberculin  test,  either  the  Pirquet  or 
Mantoux.  My  use  of  the  intracutaneous 
method  of  Mantoux  in  the  past  six  years 
has  led  'me  to  believe  strongly  in  its  ac- 
curacy and  hypersensitiveness,  and  I pre- 
fer it  as  a method  of  choice.  This  test 
simply  consists  in  the  use  of  old  tuberculin 
in  dilution  with  normal  saline  in  such  pro- 
portions that  dilution  “A”  contains  1 mgm. 
of  tuberculin  in  .1  cc.,  dilution  “B”  .1 
mgm.  of  tuberculin  in  .1  cc,  and  dilution 
“C”  .01  mgm.  in  .1  cc.  Twenty-five  per 
cent  phenol  should  be  added  as  a preserva- 
tive and  these  solutions  should  be  made 
up  fresh  every  ten  days  to  two  weeks. 

The  flexor  surface  of  the  forearm  is  se- 
lected, cleansed  with  alcohol,  and  a tuber- 
culin syringe  and  a 26  guage  needle  is 
used.  .1  cc.  of  dilution  “C”  is  used.  In- 
jection should  be  made  intracutaneously 
and  when  finished  should  leave  a blanched 
out  elevated  wheal.  If  no  reaction  ap- 
pears in  the  way  of  an  area  of  redness  and 
edema  in  twenty-four  to  ninety-six  hours, 
the  test  is  repeated,  using  .1  cc.  dilution 
“B”.  If  no  reaction  occurs  in  twenty-four 
to  ninety-six  hours,  the  test  is  again  re- 
peated, using  .1  cc.  dilution  “A”.  The  in- 
terpretation of  this  means  that  if  positive 
test  is  not  obtained  with  either  of  the 
above  dilutions,  one  may  conclude  that  the 
child  is  not  infected  at  that  time.  When  a 
positive  reaction  does  occur,  it  usually  ap- 
pears within  twenty-four  to  forty-eight 
hours  and  consists  of  a deep  red  nodule, 
varying  in  size  from  one-half  to  one  inch 
in  diameter,  with  a surrounding  halo  of 
pinkness.  This  indicates  the  existence  of 
tuberculosis.  If  a strong  result  is  obtain- 
ed, either  a recent  or  active  tuberculous 
infection  is  determined. 


Radiographic  method:  Radiography  is 
one  of  the  most  useful  methods  of  diagno- 
sis at  our  disposal,  and  every  child  show- 
ing a positive  tuberculin  test  should  be 
X-rayed.  A negative  radiograph,  how- 
ever, should  not  refute  a diagnosis  other- 
wise established.  The  lesions  small  in  the 
parenchyma  or  hilum  may  cast  no  shadow 
on  the  film.  Repeated  check-up  with  the 
X-ray  on  the  positive  reactor  is,  I believe, 
imperative.  The  hilum  alone  or  tracheo- 
bronchial nodes  may  show  evidence  of  dis- 
ease, the  initial  lesion  being  in  some  re- 
mote part  of  the  body.  If  in  the  lung  it 
may  be  obscured  by  the  ribs,  diaphragm 
or  heart,  and  for  this  reason  be  difficult 
to  detect.  The  tracheo-bronchial  glands 
enlarged  cannot  always  be  demonstrated 
radiographically  because  of  their  position 
in  the  mediastinum  where  they  are  mask- 
ed by  the  heart  and  large  blood  vessels. 
Again  the  interpretation  of  a chest  film 
for  tuberculosis  in  children  should  be  left 
to  those  particularly  skilled  in  radio- 
graphic  diagnosis  of  juvenile  tuberculosis. 
The  thorough  physical  examination  should 
always  be  conducted,  even  though  it  is  fre- 
quently disappointing.  Extensive  involve- 
ment may  give  physical  signs  of  an  ordi- 
nary pneumonia.  Smaller  areas  may  give 
indefinite  rales,  with  slight  abnormal 
changes  of  breath  sounds  in  the  bases.  If 
the  tracheo-bronchial  nodes  are  extensive- 
ly enlarged,  interscapular  dullness  may  be 
elicited. 

Laboratory  methods  consist  in  the  ex- 


Fig.  3 — F.  S.,  male,  age  7.  Mantoux  test  4 
plus  positive.  Marked  bilateral  tracheo-bron- 
chial and  hilar  childhood  tuberculosis  with  paren- 
chymal extension. 


October,  1934]  ARKANSAS  MEDICAL  SOCIETY 


77 


animation  of  feces.  If  acid  fast  organ- 
isms are  found,  guinea  pig  inoculations 
should  be  done.  Aspiration  of  stomach 
contents  to  examine  for  tubercle  bacilli  is 
a worthy  procedure. 

Finally  the  diagnosis  rests  upon  the  his- 
tory, laboratory,  tuberculin  test  and  X- 
ray.  If  the  tuberculin  test  is  positive  and 
the  X-ray  shows  positive  findings,  one  is 
justified  in  making  a diagnosis  of  child- 
hood tuberculosis  in  the  absence  of  any 
other  evidence. 

Thus  we  have  a practical  and  reliable 
procedure  for  the  diagnosis  of  tubercu- 
losis in  children.  It  should  be  carried  out 
in  all  our  schools  and  public  institutions, 
particularly  among  children  whose  history 
of  contact  can  be  ascertained  by  the  school 
nurse.  We  have  done  this  on  a part  of 
our  children  in  the  Fort  Smith  schools  and 
have  shown  some  thirty-nine  per  cent  re- 
coveries on  purely  contact  cases,  a subse- 
quent report  of  which  we  hope  to  give  you 
l^tcr 

100  South  13th  Street. 

BIBLIOGRAPHY 

1.  J.  A.  Myers:  Tuberculosis  Among  Children. 
C.  C.  Thomas,  Publisher,  1930. 

2.  Henry  D.  Chadwick:  Tuberculosis  in  Chil- 
dren and  Adolescents.  Journal  of  Michigan  State 
Society.  31:109-113,  February,  1932. 

DISCUSSION 

J.  D.  RILEY,  Booneville:  I enjoyed  Dr.  Blair’s 
paper.  I think  it  is  a very  tamely  one,  one  which 
is  very  important  to  the  Society.  There  is  not 
a thing  more  important  than  the  diagnosis  of 
childhood  tuberculosis.  The  diagnosis  of  child- 
hood tuberculosis,  as  he  said  in  his  brief  manner, 
and  yet  he  covered  the  field,  depends  upon  the 
history  of  contact  and  the  tuberculin  test,  fol- 
lowed by  an  X-ray  examination.  The  interpre- 
tation of  the  X-ray  pictures  in  childhood  tuber- 
culosis is  a very  difficult  matter.  The  picture 
most  likely  to  be  shown  to  you  as  childhood  tuber- 
culosis is  one  in  which  you  can  easily  see  it,  where 
the  child  has  to  a great  extent  already  passed 
through  the  stage  of  healing  tuberculosis.  There- 
fore, it  behooves  one  trying  to  interpret  an  X-ray 
picture  of  childhood  tuberculosis  to  look  for  the 
early  Kahn  tubercle  which  is  not  easily  seen, 
which  is  not  clearly  outlined,  which  carries  you 
almost  to  a negative  X-ray  picture;  for  it  is 
then  that  your  tuberculosis  is  beginning,  it  is 
then  that  it  is  active,  and  it  is  then  that  the  child 
needs  treatment  for  tuberculosis,  more  so  than 
after  calcification  has  taken  place  which  indicates 
that  there  is  quite  a bit  of  healing. 

I think  his  paper  was  very  comprehensive  and 
to  the  point  and  I think  it  one  of  the  things  that 
should  be  given  consideration  by  the  physicians 
of  Arkansas.  Future  generations  will  see  many 
people  suffering  from  this  disease  because  child- 
hood tuberculosis  is  not  diagnosed. 


THE  RELATIONSHIP  OF  ALLERGY 
TO  OTOLARYNGOLOGY 
John  Shea 

Discussion  by  L.  H.  Lanier,  Texarkana 

I want  to  say  that  this  paper  was 
brought  to  us  by  a master  in  this  work. 
I am  very  much  interested  in  Dr.  Shea 
mentioning  migraine  and  its  relationship 
to  allergy,  in  view  of  the  fact  that  I re- 
cently had  a case  that  had  responded  nice- 
ly to  treatment  after  finding  what  that 
patient  was  sensitive  to  and  eliminating 
that  by  desensitization  through  diet.  Be- 
fore I moved  to  Texarkana  I had  a case 
of  angioneurotic  edema,  the  first  case  in 
which  I ever  received  a one  thousand  dol- 
lar fee.  Of  course,  I won’t  forget  that. 
This  gentleman  had  taken  his  wife  to  Dr. 
Sutton  in  Kansas  City  and  to  various 
specialists  in  Boston  and  New  York,  and 
they  all  had  a habit  of  charging  him  a 
thousand  dollar  fee.  None  of  them  had 
been  successful  in  curing  her  angioneu- 
rotic edema.  I found  through  talking  with 
her  daughter  that  this  lady  was  accus- 
tomed to  dyeing  her  hair  every  few  days. 
I found  that  she  was  using  a walnut  hair 
dye,  a Rexall  hair  dye,  and  that  is  what 
she  was  sensitive  to.  I had  her  stop  it 
and  cured  her  angioneurotic  edema,  and 
this  gentleman  made  good  and  gave  me 
one  thousand  dollars. 

In  hay  fever,  my  experience  has  shown 
that  specific  therapy  should  not  be  un- 
dertaken in  the  presence  of  pathologic 
conditions  in  the  nose  or  accessory  sinuses. 
It  has  not  been  proven  that  the  removal 
of  polyps  or  similar  operations  has  cured 
hay  fever  patients,  but  it  has  been  proven 
that  such  operations  may  be  necessary  if 
subsequent  therapy  is  to  be  successful. 

It  is  safe  to  say  that  the  method  of 
treating  hay  fever  patients  by  early  pro- 
phylactic injections  of  the  indicated  pol- 
len extracts,  combined  with  late  and  in- 
tensive injections  of  autogenous  bacterial 
vaccines,  offers  the  greatest  therapeutic 
promise  of  any  method  so  far  advanced  in 
the  treatment  of  this  disease.  Pollen  ex- 
tracts alone  and  bacterial  vaccines  alone, 
while  beneficial,  do  not  seem  to  relieve  so 
many  patients  as  does  the  combined  ther- 
apy. 

It  is  well  to  remember  that  injections 
one  year  do  not  prevent  attacks  the  sue- 


78 


THE  JOURNAL  OF  TH  E 


[Vol.  XXXI,  No.  5 


ceeding  year,  but,  in  patients  receiving 
treatment  continued  from  year  to  year, 
there  is  a definite  tendency  for  the  hay 
fever  symptoms  to  become  progressively 
less  severe. 

I was  greatly  interested  in  Dr.  Shea 
mentioning  the  nasal  reflexes  in  their  re- 
lationship to  asthma,  and  I hope  that  he 
will  dilate  on  that  a little  bit  in  his  closing 
remarks. 

Editorial  Note — Through  an  oversight,  the 
above  discussion  by  Dr.  Lanier  was  not  published 
with  Dr.  Shea’s  paper  in  the  September  issue  of 
The  Journal.  This  is  regretted  and  in  justice  to 
Dr.  Lanier,  his  discussion  is  printed  here  with  the 
apology  of  The  Journal. 

<S> 

The  first  International  Assembly  of  the  Inter- 
State  Postgraduate  Medical  Association  of  North 
America  to  be  held  east  of  the  Alleghenies  is  to 
take  place  in  the  public  auditorium  of  Philadel- 
phia, Pennsylvania,  November  5th,  6th,  7th,  8th 
and  9th,  1934,  with  pre-Assembly  clinics  on  No- 
vember 3rd,  and  post-Assembly  clinics  on  Novem- 
ber 10th  in  the  Philadelphia  Hospitals. 

The  Inter-State  Postgraduate  Medical  As- 
sociation was  organized  at  Freeport,  Illinois, 
September  26th,  in  1916,  primarily  as  a three- 
state  organization  (Illinois,  Iowa  and  Wiscon- 
sin). Its  rapid  development  as  a postgraduate 
institution  soon  gave  the  organization  a national 
and  international  reputation  and  it  was  found 
advisable  for  the  best  interest  of  the  medical  pro- 
fession not  to  confine  the  membership  to  that  of 
the  three  states,  but  to  extend  it  and  the  work  of 
the  organization  to  that  of  the  surrounding  states 
and  finally  to  that  of  the  entire  United  States 
and  Canada,  and  through  its  foreign  department, 
different  countries  of  the  world. 

The  organization  is  purely  a postgraduate 
medical  association.  It  exercises  no  political  nor 
legislative  duties.  It’s  object  is  to  give  to  the 
medical  profession  the  very  latest  and  best  there 
is  to  be  had  in  medical  science  in  the  most  prac- 
tical and  beneficial- manner,  therefore,  it  is  the 
aim  of  the  international  assemblies  to  present  to 
the  profession  the  approved  advancements  of 
medical  science  and  research,  not  unmindful  of 
the  practical  side  of  medical  study.  To  this  end 
diagnostic  clinics,  orations,  symposia  and  discus- 
sions are  offered  by  the  leading  teachers  and 
clinicians,  most  of  whom  are  members  of  facul- 
ties or  connected  with  the  outstanding  medical 
universities. 

In  the  words  of  Dr.  William  J.  Mayo,  “The 
Inter-State  Postgraduate  Assembly  is  composed 
of  the  rank  and  file  of  the  medical  profession 
who  are  in  good  standing  in  their  state  or  pro- 
vincial societies.  It’s  members  are  practitioners 
who  come  in  direct  contact  with  the  people,  and 
what  they  learn  therefore  has  immediate  appli- 
cation.” 

Through  the  combined  efforts  of  the  medical 


profession  of  Philadelphia,  which  is  noted  for 
it’s  high  medical  standing  and  great  institutions 
of  medical  education,  a stage  is  being  set  for  a 
most  wonderful  medical  assembly,  which  is  bound 
to  contribute  a great  deal  of  valuable  scientific 
and  clinical  knowledge  to  the  medical  profes- 
sion of  North  America.  The  program  has  been 
carefully  arranged  to  meet  the  demands  of  the 
general  practitioner,  as  well  as  the  specialist. 
Extreme  care  has  been  given  in  the  selection  of 
the  contributors  and  the  subjects  of  their  con- 
tributions. 

The  Philadelphia  County  Medical  Society  will 
be  host  to  the  assembly  and  has  arranged  an  ex- 
cellent list  of  committees  that  will  function 
throughout  the  assembly.  A most  hearty  invi- 
tation is  extended  to  all  members  of  the  profes- 
sion who  are  in  good  standing  in  their  state  or 
provincial  societies,  to  be  present  and  enjoy  the 
hospitality  of  Philadelphia,  “The  City  of  Broth- 
erly Love.” 

The  aggressive  and  up-to-date  Convention  Bu- 
reau of  Philadelphia  is  co-operating  in  every  way. 

<♦> 

Correspondence 


Elkins,  Ark.,  September  4,  1934. 
Editor,  Journal  of  the  Arkansas  Medical  Society,. 
Dear  Doctor: 

I am  quite  interested  in  the  article  on  page  66, 
of  the  September  number  of  the  Journal,  “The 
Therapy  of  Malaria.” 

I came  from  Wisconsin  to  Arkansas  some  four 
years  ago  and  was  nonplussed  with  my  first  case 
of  malaria.  Malaria  is  rarely  found  in  the 
northern  states,  and  I had  never  seen  a case  be- 
fore. And  as  the  disease  refused  to  respond  to 
the  quinine  treatment  I was  about  to  declare  my- 
self mistaken  in  the  diagnosis. 

I discussed  my  case  with  the  local  durggist, 
W.  0.  Bedingfield,  who  said  that  he  had  a pre- 
scription left  to  him  by  the  late  Dr.  Charles  Swift, 
that  worked  miracles  with  malaria.  Dr.  Swift 
had  obtained  the  prescription  from  a physician 
in  Louisiana  who  practiced  medicine  among  the 
bayous,  marshes,  bogs  and  other  low  water  areas 
along  the  Mississippi  river.  The  name  of  the 
Louisiana  physician  I could  not  learn,  but  here 
is  his  prescription: 

R Quinine  Bisulphatis  dr.  ii 

Tr.  Ferri  Chloridi  dr.  v 

Tr.  Iodidi  q.  s.  oz.  i 

Misce. 

Sig.  Fill  a 00  capsule  and  take 
after  each  meal. 

Care  must  be  taken  in  compounding  the  mix- 
ture as  a CLEAR  solution  is  imperative. 

Needless  to  say  my  malaria  case  cleared  im- 
mediately and  I have  used  no  other  remedy  with 
the  numerous  cases  I have  attended  since. 

As  the  ads  say:  “After  one  trial  you  will  use 
no  other.” 

Fraternally, 

H.  B.  WENTZ,  M.  D. 


October,  1934]  ARKANSAS  MEDICAL  SOCIETY 


79 


THE  JOURNAL 

OP  THE 

Arkansas  Medical  Society 


Owned  by  the  Arkansas  Medical  Society  and  Published 
under  direction  of  the  Council. 


DR.  W.  R.  BROOKSHER,  Editor 
610  First  National  Bank  Bldg.,  Fort  Smith,  Arkansas 


The  advertising  policy  of  this  Journal  is  governed  by 
the  rules  of  the  Council  on  Pharmacy  and  Chemistry  of 
the  American  Medical  Association. 

All  communications  to  this  Journal  must  be  made  to 
it  exclusively.  Communications  and  items  of  general 
interest  to  the  profession  are  invited  from  all  over  the 
State.  Notice  of  deaths,  removals  from  the  State, 
changes  of  location,  etc.,  are  requested. 


OFFICERS  OF  THE  ARKANSAS  MEDICAL  SOCIETY 

F.  O.  MAHONY,  President El  Dorado 

M.  E.  McCASKILL,  Presidtnt-Elect Little  Rock 

A.  M.  ELTON,  First  Vice-President Newport 

S.  C.  FULMER,  Second  Vice-President Little  Rock 

F.  D.  SMITH,  Third  Vice-President Blytheville 

R.  J.  CALCOTE.  Treasurer Little  Rock 

W.  R.  BROOKSHER,  Secretary Fort  Smith 


COUNCILORS 

First.  District — W.  M.  MAJORS Paragould 

Second  District — S.  J.  ALLBRIGHT Searcy 

Third  District — M.  C.  JOHN Stuttgart 

Fourth  District — -C.  W.  DIXON Gould 

Fifth  District — L.  L.  PURIFOY El  Dorado 

Sixth  District — DON  SMITH Hope 

Seventh  District — GEO.  B.  FLETCHER  -Hot  Springs 

Eighth  District— S.  B.  HINKLE Little  Rock 

Ninth  District — D.  L.  OWENS  - -Harrison 

Tenth  District — S.  J.  WOLFERMANN Fort  Smith 


COMMITTEES : 

((Appointments  expire  in  the  year  indicated.) 

Scientific  Work — L.  L.  Purifoy,  Chairman  ; El  Do- 
rado (1935)  ; R.  B.  Robins,  Camden  (1936)  ; W.  R. 
Brooksher,  Fort  Smith  (1937). 

Medical  Legislation — Val  Parmley,  Chairman,  Little 
Rock  (1937);  M.  L.  Norwood,  Lockesburg  (1937);  O. 
L.  Williamson,  Marianna  (1937)  ; H.  T.  Smith,  Mc- 
Gehee  (1936)  ; R.  L.  Smith,  Russellville  (1936)  ; A.  S. 
Buchanan,  Prescott  (1935)  ; H.  A.  Dishongh,  Little 
Rock  (1935). 

Health  and  Public  Instruction — W.  B.  Grayson, 
Chairman,  Little  Rock  (1937)  ; S.  W.  Douglas,  Eu- 
dora  (1937)  ; B.  M.  Stevenson,  Crawfordsville  (1937)  ; 
H.  K.  Carrington,  Magnolia  (1936)  ; H.  A.  Stroud 
Jonesboro  (1936)  ; J.  H.  Fowler,  Harrison  (1935).  E. 
J.  Munn,  El  Dorado  (1935). 

Medical  Education  and  Hospitals— Joe  F.  Shuffield, 
Chairman,  Little  Rock  (1937)  ; David  Levine,  El  Do- 
rado (1936)  ; J.  B.  Futrell,  Rector  (1935). 

Public  Relations — D.  A.  Rhinehart,  Chairman,  Lit- 
tle Rock  (1937)  ; E.  E.  Barlow,  Dermott  (1936)  ; M. 
E.  McCaskill,  Little  Rock  (1935). 

Medical  Economics — I.  F.  Jones,  Chairman,  Fort 
Smith  (1937)  ; R.  B.  Robins,  Camden  1937)  ; J.  E. 
Neighbors,  Stuttgart  (1936)  ; D.  E.  White,  El  Dorado 
(1936)  ; Roy  Millard,  Dardanelle  (1935)  ; A.  C.  Shipp, 
Little  Rock  (1935)  ; R.  M.  Sloan,  Jonesboro  (1935). 

Scientific  Exhibit — F.  H.  Krock,  Chairman,  Fort 
Smith  (1935)  ; H.  King  Wade,  Hot  Springs  National 
Park  (1936)  ; W.  E.  Gray,  Jr.,  Little  Rock  (1937). 

Arrangements. — (Host  Society  1935  meeting) — D.  W. 
Goldstein,  Chairman.  C.  S.  Holt,  J.  A.  Foltz,  H.  Moul- 
ton, M.  E.  Foster,  W.  G.  Elberle,  I.  F.  Jones. 

Necrology — W.  H.  Mock,  Chairman,  Prairie  Grove 
(1935)  ; J.  M.  Lemons,  Pine  Bluff  (1936)  ; H.  Moul- 
ton. Fort  Smith  (1937). 

Auxiliary — L.  J.  Kosminsky,  Chairman,  Texarkana 
(1935)  ; H.  T.  Wootton,  Hot  Springs  National  Park 
(1936)  ; C.  S.  Holt,  Fort  Smith  (1937). 

Cancer  Control — D.  W.  Goldstein,  Chairman,  Fort 
Smith  (1937)  ; R.  L.  Saxon.  Little  Rock  (1936)  ; L. 
A.  Purifoy,  El  Dorado  (1935). 


EDITORIALS 

At  the  present  time  there  are  1,002 
physicians  in  good  standing  in  the  Arkan- 
sas Medical  Society,  a figure  which  com- 
pares favorably  with  the  880  of  1933 ; the 
954  of  1932,  and  the  1,013  of  1931,  but 
which  appears  discouraging  when  the 
1,151  members  of  an  early  depression  year, 
1930,  are  considered.  It  would  appear 
that  reduction  of  dues  is  not  per  se  suffi- 
cient inducement  for  the  enrollment  of  all 
eligible  physicians  and  that  there  are  other 
factors  involved  in  this  loss  of  member- 
ship. There  are  as  yet  some  thirty  or 
forty  physicians,  members  in  1933,  whose 
1934  dues  have  not  been  paid.  Efforts  in 
the  state  secretary’s  office  to  secure  these 
dues  have  been  unsuccessful  and  it  would 
appear  that  the  reinstatement  of  these 
members  will  of  necessity  be  accomplished 
by  time  and  effort  on  the  part  of  their 
respective  county  society  colleagues.  It  is 
to  be  hoped  that  such  activity  will  result 
in  order  that  as  -large  a roster  as  possible 
may  be  published  in  the  November  issue 
of  The  Journal. 

It  must  not  be  overlooked  that  dues  from 
the  present  membership  of  1,000  produces 
a revenue  equal  to  that  from  but  600  mem- 
bers paying  the  constitutional  assessment. 
A careful  study  of  the  roster  leads  to  the 
impression  that  with  the  dues  at  the  old 
level  far  more  than  this  meager  number 
would  even  now  be  in  good  standing,  thus 
increasing  the  income  of  the  society  by 
forty  per  cent.  The  pressure  of  economic 
changes,  in  effect  and  proposed,  requires 
active  and  unified  opposition  from  all  phy- 
sicians and  similarly  increases  the  expen- 
ditures for  the  operation  of  the  Society. 
It  is  felt  that  a return  to  the  dues  for- 
merly in  effect  will  be  of  definite  advant- 
age to  the  society,  decreasing  the  present 
membership  in  but  slight  degree,  while 
affording  much  more  adequate  funds  for 
operation. 



We  are  gratified  with  hearing  from  de- 
tail men,  manufacturers  and  advertisers 
that  members  of  the  Arkansas  Medical 
Society  are  expressing  their  preference  for 
/ortnmLadvertised  products.  Such  good 
news  has  reached  us  from  several  sources 
lately.  The  influence  of  this  support  of 
our  advertisers  is  far-reaching;  loyal  ad- 
vertisers of  years  are  induced  to  continue 
a profitable  investment  in  space;  new  ad- 
vertisers are  added,  and  contacts  are  af- 


80 


THE  JOURNAL  OF  TH  E 


[Vol.  XXXI,  No.  5 


forded  for  the  successful  solicitation  of 
new  accounts.  If  each  member  would 
confine  his  patronage  to  advertised  pro- 
ducts, other  things  being  equal,  mainte- 
nance of  our  advertising  pages  would  be 
a simple  task.  Advertising  is  the  means 
whereby  this  Journal  is  published;  your 
hearty  co-operation  with  these  firms 
makes  for  a better,  larger  Journal.  A com- 
parison of  the  September,  1933,  and  Sep- 
tember, 1934,  issues  is  of  interest.  Thir- 
teen pages  of  commercial  advertising  were 
carried  in  1933;  17  in  1934.  This  gain 
of  four  pages,  despite  some  losses,  is  most 
encouraging  and  accounts  for  a revenue 
gain  of  33  1-3  per  cent  for  the  month. 
Other  new  advertisers  appear  with  this  is- 
sue. We  are  asking  that  you  review  the 
advertising  pages,  familiarize  yourself 
with  the  products  and  services  offered, 
and  support  our  friends  by  word  of  mouth 
and  patronage.  An  improved  Journal  will 
justify  your  action. 

<$> 

Resolution 


Whereas,  Doctor  J.  Vance  Ferguson 
was  called  by  death  at  Rochester,  Minne- 
sota on  the  8th  day  of  July,  1934,  after  a 
long  illness,  and 

Whereas,  in  the  death  of  Doctor  Fer- 
guson, Union  County  and  the  State  of 
Arkansas  lost  one  of  its  most  able  and 
distinguished  physicians  and  surgeons, 
and 

Whereas,  in  the  death  of  Doctor  Fer- 
guson, Union  County  lost  one  of  its  most 
able  and  respected  citizens,  and 

Whereas,  in  the  death  of  Doctor  Fer- 
guson, this  Society  has  lost  one  of  its  most 
useful  and  beloved  brothers, 

Now,  THEREFORE,  BE  IT  RESOLVED,  that 
this  Society  manifests  its  regret  of  the 
loss  of  Doctor  Ferguson  by  entering  this 
resolution  upon  the  minutes  of  this  meet- 
ing, and  that  it  expresses  its  sympathy 
to  the  surviving  members  of  his  family  by 
sending  a copy  of  this  resolution  to  his 
father  and  mother. 

UNION  COUNTY  MEDICAL  SOCIETY, 
L.  A.  Purifoy,  President. 

F.  L.  Irby,  Secretary. 
Resolutions  Committee: 

F.  O.  Mahony,  Chairman. 

D.  E.  White. 

David  Levine. 


PAYMENTS  BY  ERA  FOR  MEDICAL 
SERVICES  TO  PERSONS  ON 
RELIEF  ROLLS 

At  a conference  of  the  Advisory  Com- 
mittee from  the  Arkansas  Medical  So- 
ciety to  the  Emergency  Relief  Adminis- 
tration with  the  Administration  on  Sep- 
tember 13th,  the  following  suggestions 
were  adopted  in  an  effort  to  create  a co- 
operative and  effective  medical  program: 

It  is  suggested  that  a Governing  Board  be 
created  in  each  county  to  serve  with  the  County 
Administrator  and  Case  Work  Supervisor.  Mem- 
bers of  this  committee  are  to  be  selected  from  or- 
ganized medical  societies.  A report  of  cases  and 
bills  will  be  presented  to  this  committee  for  ap- 
proval or  rejection.  If  a physician  should  in- 
dulge in  irregular  and  unfair  practices,  he  will 
be  automatically  dropped  from  the  list  of  licensed 
competent  physicians  eligible  for  calls. 

Case  Work  Supervisors  will  not  make  authori- 
zation for  visits  to  a case  of  chronic  illness  for 
more  than  a period  of  two  months,  allowing  one 
visit  per  week  to  the  client.  Acute  illness  will 
have  authorization  for  not  more  than  six  visits. 
(If  additional  visits  are  required,  special  authori- 
zation in  writing  must  be  given  through  the  Case 
Work  Supervisor  and  the  County  Administrator.) 
Physicians  not  living  in  the  city  or  town  where 
headquarters  of  the  Case  Work  Department  is 
established  may  make  calls  in  emergencies  and 
request  the  authorization  slips  after  the  visit  has 
been  made.  These  requests  will  be  honored  only 
when  clients  are  on  relief  rolls. 

It  is  suggested  that  the  Emergency  Relief  Ad- 
ministration solicit  the  co-operation  of  the  State 
Board  of  Health  in  securing  the  services  of  the 
full-time  and  part-time  County  Health  Officers 
and  the  assistance  of  the  County  Health  and 
Emergency  Relief  Nurses  in  administering  anti- 
rabic,  smallpox,  diphtheria  and  typhoid  serums 
and  vaccines,  the  local  Relief  Administration 
furnishing  the  necessary  biologicals. 

It  is  further  suggested  that  the  physicians  co- 
operate in  every  way  possible  in  attempting  to 
control  the  expenditure  of  funds  for  medications 
and  medical  supplies.  If  a case  requires  castor 
oil,  quinine,  aspirin,  or  other  common  remedy,  it 
is  requested  that  a note  signed  by  the  physician 
be  given  the  Case  Work  Supervisor  who  will 
then  issue  order  for  the  medication  from  the 
Commissary.  This  will  avert  excessive  expendi- 
ture incident  to  prescription  filling  of  the  more 
commonly  used  drugs,  conservation  of  limited 
available  funds  being  necessary. 

It  is  the  desire  of  the  Emergency  Relief  Ad- 
ministration that  reputable  physicians  through- 
out the  state  co-operate  energetically  and  enthu- 
siastically in  the  effort  to  provide  medical  service 
to  needy  clients.  Adequate  funds  are  not  avail- 
able to  compensate  physicians  for  full  service.  It 
is  not  within  the  meaning  of  this  intention  to 
pauperize  clients  by  deviation  from  fees  custom- 
arily charged,  nor  should  publicity  be  given  to 


October,  1934]  ARKANSAS  MEDICAL  SOCIETY 


81 


the  adopted  schedule  of  fees.  Every  precaution 
to  avoid  any  misunderstanding  between  physi- 
cians and  patients  will  be  taken.  The  Emergen- 
cy Relief  Administration  is  only  attempting  to 
partially  repay  physicians  of  the  state  for  services 
which  they  have  been  furnishing  without  fee  of 
any  kind. 

The  following  fee  schedule  was  placed 
in  effect  by  the  relief  administration  on 
September  14th: 

Office  Visits  $ 1.00 

Home  Visits,  day  time,  city  limits 1.50 

Home  Visits,  city  limits  (6  p.  m.  to  8 a.  m.)  3.00 

(Authorized  in  emergencies  only.) 

Country  calls,  the  same  fee  as  town  calls, 
plus  a mileage  allowance  of  twenty-five 
cents  per  mile,  one  way,  with  a limit  of 
ten  miles.  For  additional  mileage  the 
physician  must  have  special  authoriza- 
tion from  county  administrator  and 
case  work  supervisor. 

General  Anesthetic  5.00 

X-ray  Examination  (emergencies  only) 

One  Exposure,  $2.00;  two  exposures 5.00 

Obstetrical  Cases  20.00 

(Including  at  least  6 pre-natal  exami- 
nations and  3 post-natal  visits.) 

Major  Surgery  35.00 

(To  include  major  fractures,  as  femur, 
pelvis,  spine,  humerus,  etc.) 

Minor  Surgery  $5.00-  10.00 

(Such  minor  surgery  as  abscesses,  su- 
ture of  small  lacerations,  etc.  $5.00.) 
(Tonsillectomy,  removal  of  cyst,  frac- 
tures of  small  bones  of  hands  and  feet, 
etc.,  $10.00.) 

Fracture  of  the  forearm  15.00 

Laboratory  (blood  smear,  urinalysis,  etc.)  1.00 
(Additional  and  necessary  laboratory 
work  may  be  authorized  at  a fee  of  one- 
half  the  usual  rate.) 

A flat  charge  of  fifty  cents  will  apply  for 
each  additional  person  attended  in  the  home  in 
addition  to  the  regular  fee  allowed  for  the  call. 

The  Committee  from  the  Society  feels 
that  this  arrangement  is  a definite  gain 
and  feels  that  the  interests  of  the  mem- 
bers have  been  protected  in  its  adoption. 
Attention  is  directed  to  certain  phases  of 
the  agreement  for  emphasis: 

1.  The  fee  schedule  is  tentative  and  is 
subject  to  revision  by  either  the  Relief  Ad- 
ministration or  the  Committee. 

2.  It  is  definitely  understood  that  the 
fees  represent  a major  reduction  from 
those  usually  charged  throughout  the  state 
and  are  so  accepted  by  physicians  as  a con- 
tribution to  the  relief  program  for  the 
needy.  The  schedule  is  tentatively  adopt- 
ed for  the  period  of  pending  rehabilita- 


tion of  those  persons  on  relief  rolls  and 
with  completion  of  such  rehabilitation,  is 
obviously  not  in  effect. 

3.  No  publicity  should  be  given  these 
particular  fees.  The  Relief  Administra- 
tion will  co-operate  in  this  by  not  advising 
the  patient  of  the  fee  which  is  being  paid 
for  his  medical  attention.  Physicians  are 
urged  not  to  discuss  the  fee  with  the  pa- 
tient. 

4.  Particular  attention  is  directed  to  the 
fact  that  the  relief  administration  will 
pay  these  fees  only  for  medical  attention 
to  persons  on  relief  rolls.  Numbers  of 
people  in  the  state  unable  to  pay  for  med- 
ical services  are  not  on  the  relief  rolls 
and  hence  payment  for  medical  services  to 
these  will  not  be  made  by  the  relief  ad- 
ministration. The  authorization  as  furn- 
ished by  the  Case  Work  Supervisor  is  the 
physicians’  guide  in  furnishing  services 
under  this  plan.  Attention  rendered  in 
the  absence  of  an  authoriaztion  will  in- 
frequently be  found  to  be  service  from 
which  no  payment  will  be  received  from 
the  Relief  Administration. 

5.  The  rendering  of  medical  services  un- 
der this  plan  is  a matter  of  individual  de- 
cision with  the  physicians  of  Arkansas  and 
is  in  no  sense  obligatory. 

6.  The  Advisory  Committee  from  the 
Arkansas  Medical  Society  bespeaks  the 
cordial  co-operation  of  the  members  in 
carrying  out  the  provisions  of  this  agree- 
ment. 

<S> 

Coming  Medical  Meetings 


Kansas  City  Southwest  Clinical  Society,  Kan- 
sas City,  October  1st  to  4th. 

Second  Councilor  District  Medical  Society, 
Batesville,  October  8th. 

Leo  N.  Levi  Memorial  Hospital  Clinical  Con- 
ference, Hot  Springs  National  Park,  October  11th. 

Fifth  Councilor  District  Medical  Society,  Cam- 
den, October  11th. 

American  College  of  Surgeons,  Boston,  Octo- 
ber 15th  to  19th. 

Oklahoma  City  Clinical  Society,  Oklahoma  City, 
October  29th  to  November  1st. 

Inter-State  Post  Graduate  Medical  Association 
of  North  America,  Philadelphia,  November  5th 
to  9th. 

Southern  Medical  Association,  San  Antonio, 
November  13th  to  16th. 

Radiological  Society  of  North  America,  Mem- 
phis, December  3rd  to  7th. 

Dallas  Southern  Clinical  Society,  Dallas,  March 
18th  to  25th,  1935. 


82 


THE  JOURNAL  OF  TH  E 


[Vol.  XXXI,  No.  5 


Proceedings  of  Societies 


The  Conway-Pope-Yell  County  Medical 
Society  met  at  Russellville  in  dinner  ses- 
sion on  August  9th.  Speakers  on  the 
scientific  program  were : L.  Gardner,  Rus- 
sellville, “The  Chronic  Discharging  Ear,” 
and  Walter  Cale,  Atkins,  “Blood  Stream 
Infection.” 


The  Tri-County  Clinical  Society  met  at 
Hope  on  August  30th  for  the  following 
program : 

Malignancy  of  the  Oral  Cavity — G.  F. 
Jackson,  Little  Rock. 

Renal  and  Ureteral  Calculi — G.  G.  Gar- 
rett, Shreveport. 

Infections  of  the  Kidney  — Wm.  Hib- 
bitts,  Texarkana. 

Marginal  Anesthesia — W.  P.  Lambert, 
Shreveport. 

C.  K.  Townsend,  Secretary. 


The  Sebastian  County  Medical  Society 
met  in  dinner  session  September  11th  with 
the  Muskogee  (Oklahoma)  County  Medi- 
cal Society  as  guests.  The  following  pro- 
gram was  presented  by  guest  speakers : 

Dehydration — F.  W.  Ewing. 

Diagnosis  and  Treatment  of  Extraute- 
rine  Pregnancy — I.  B.  Oldham. 

Vesical  Neck  Resection — E.  H.  Fite.  - 
J.  W.  Amis,  Secretary. 


The  staffs  of  the  Leo  N.  Levi  Memorial 
Hospital  and  the  Charles  Steinberg  Clinic 
will  hold  their  fourth  Clinical  Conference 
on  Thursday,  October  11. 

Guest  speakers  will  be  Dr.  George  R. 
Livermore,  Professor  of  Urology,  Univer- 
sity of  Tennessee  and  immediate  past 
president  of  the  American  Urological  As- 
sociation; and  Colonel  W.  B.  Meister, 
Chief  of  the  Medical  Service,  Army  and 
Navy  General  Hospital,  Hot  Springs  Na- 
tional Park. 

The  conference,  as  conducted  last  year, 
will  consist  of  lectures,  demonstrations, 
and  clinics  on  medical  and  surgical  sub- 
jects, the  material  of  which  will  be  so  se- 
lected as  to  be  of  especial  interest  to  the 
general  practitioner.  Members  of  the 
staffs  will  present  cases  and  clinical  re- 
ports, instead  of  reading  papers.  The  lec- 


tures and  demonstrations  will  be  concise, 
and  exactly  to  the  point. 

The  conference  will  begin  promptly  at 
nine  o’clock  on  Thursday,  October  11  and 
will  close  Thursday  evening  with  an  in- 
formal dinner  at  the  Arlington  Hotel,  at 
which  time  Dr.  Livermore  will  present  his 
subject. 

No  registration  fee  will  be  charged. 


Twenty-five  members  of  the  faculty  of 
the  University  of  Tennessee  Medical 
School  were  guests  of  honor  at  a barbe- 
cue given  by  the  Mississippi  County  Med- 
ical Society  at  Blytheville,  September  14. 
The  reunion  was  attended  by  approximate- 
ly 150  physicians,  many  of  whom  were 
former  students  at  the  school.  The  fol- 
lowing program  was  presented : 

Reminiscences  of  the  University  Dur- 
ing the  Past  40  Years — B.  F.  Turner. 

The  Importance  of  Alumni  Associations 
— 0.  W.  Hyman. 

Connections  Between  the  Old  and  the 
New  Universities — J.  B.  McElroy. 

Memorial  to  W.  B.  Rogers — Battle  Ma- 
lone. 

Pleasant  Associations  With  the  Teach- 
ing Staff — J.  A.  Crisler. 

Tribute  to  Deceased  Faculty  Members 
— J.  L.  Andrews. 

Old  and  New  Methods  of  Teaching 
Anatomy — E.  E.  Francis. 

Practical  Jokes  on  Myself — E.  M.  Hol- 
der. 

F.  D.  Smith,  Secretary. 

<§> 

Specialists  in  the  study  of  child  nutrition  have 
been  quick  to  recognize  the  value  of  milk  as  the 
mainstay  of  the  child’s  diet. 

“But  what,”  asks  the  frantic  mother  of  a young- 
ster who  dislikes  milk,  “can  I do  to  make  my 
child  eagerly  want  that  which  he  now  rebels 
against?” 

Today  the  doctor  who  is  confronted  with  this 
query  can  solve  this  age-old  problem  by  the  help- 
ful advice  to  mix  Cocomalt  with  the  milk.  For  by 
the  simple  addition  of  Cocomalt,  milk  not  only 
becomes  a delicious  chocolate  flavor  drink — but 
its  food-energy  value  is  practically  doubled.  Coco- 
malt in  milk  provides  extra  proteins,  carbohy- 
drates and  minerals  (food-calcium  and  food-phos- 
phorus). It  is  also  a rich  source  of  Vitamin  D. 

Thus  Cocomalt  not  only  induces  youngsters  to 
drink  all  the  milk  they  require — it  provides  extra 
food-energy  value  as  well  and  a rich  supply  of 
Vitamin  D. 


October,  1934]  ARKANSAS  MEDICAL  SOCIETY 


83 


Personal  and  News  Items 


Dr.  E.  F.  Ellis,  Fayetteville,  entertain- 
ed at  an  unique  birthday  celebration 
August  20th  at  his  home.  His  guests 
were  all  physicians  who  have  been  in  ac- 
tive practice  for  over  fifty  years ; Drs.  H. 
D.  Wood,  Fayetteville;  E.  G.  McCormick, 
Prairie  Grove;  A.  S.  Gregg,  Fayetteville; 
and  W.  J.  Curry,  Rogers. 


Dewell  Gann,  Jr.,  has  been  appointed 
Contributing  Editor  to  The  Mississippi 
Doctor. 


After  42  years  of  active  practice  in  Lit- 
tle Rock,  Dr.  Francis  Vinsonhaler  retired 
on  September  first  in  order  that  he  might 
devote  his  full  time  to  his  duties  as  Dean 
of  the  Medical  School  of  the  University 
of  Arkansas.  Dr.  K.  W.  Cosgrove,  his  as- 
sociate for  seven  years,  will  carry  on  the 
practice. 


C.  C.  Bass,  New  Orleans,  addressed  the 
August  meeting  of  the  Washington  Coun- 
ty Medical  Society. 


E.  D.  McKnight,  Brinkley,  attended  the 
meeting  of  the  American  Railway  Sur- 
geon’s Association  in  Chicago  during 
August  and  then  spent  a vacation  in 
Alaska. 


Martin  C.  Hawkins,  Searcy,  spent  three 
weeks  in  post-graduate  study  at  the  Mayo 
Clinic  during  August. 


Joe  Rushton,  formerly  of  Shreveport, 
has  located  in  Magnolia  and  will  be  asso- 
ciated with  the  Magnolia  Sanitarium. 


“Seventy-Four  Medical  Facts  Worth 
Knowing,”  by  A.  S.  Buchanan,  Prescott, 
appears  in  the  August  issue  of  The  Tri- 
State  Medical  Journal. 


M.  F.  Lautmann  has  returned  to  Hot 
Springs  from  a summer  spent  in  the  East. 
Dr.  Lautmann  appeared  on  the  program 
of  the  American  Congress  of  Physical 
Therapy  September  10th  discussing  the 
paper  of  Drs.  Kovacs  of  New  York  on 
“Newer  Aspects  of  Iontophoresis  in  the 
Treatment  of  Arthritis  and  Circulatory 
Disturbances.” 


The  following  attended  medical  reserve 
officer  camps  during  the  summer  train- 
ing period:  Alan  A.  Gilbert,  Fayetteville; 
Sloan  McKinney,  Little  Rock,  and  Charles 
H.  Reagan,  Marked  Tree. 


“Compression  Fractures  of  Vertebral 
Bodies”  by  Val  Parmley,  appears  in  the 
September  issue  of  The  American  Jour- 
nal of  Surgery. 


J.  T.  Powell,  Gravette,  was  host  to  the 
Benton  County  Medical  Society  at  a ban- 
quet session  August  16th. 


J.  PI.  Lamb,  Paragould,  addressed  the 
Greene  County  Medical  Society  Septem- 
ber 13th  on  “The  Modern  Methods  of 
Treatment  of  Pneumonia.” 


Obituary 


WILLIAM  H.  McKIE,  aged  54,  died  at 
Wynne  on  August  31st.  He  was  born  at 
Vanndale  June  13,  1880,  and  attended 
Hendrix  College,  the  University  of  Arkan- 
sas and  the  University  of  Tennessee  Med- 
ical School.  He  had  practiced  in  Cross 
County  for  30  years.  He  is  survived  by* 
his  wife,  his  father,  Dr.  J.  D.  McKie,  of 
Wynne,  a son  and  a daughter. 


WILLIAM  C.  MOBLEY,  Blue  Moun- 
tain, died  July  6th,  1934,  at  the  age  of 
76.  He  was  born  January  15,  1858,  in 
Tennessee  but  had  lived  in  Arkansas  for 
all  but  two  years  of  his  life.  He  gradu- 
ated from  the  Missouri  School  of  Medicine 
in  1886  and  had  practiced  at  Riley  and 
Blue  Mountain.  He  is  survived  by  his 
wife,  two  daughters  and  eight  sons,  of 
whom  two  are  physicians,  Drs.  H.  E.  Mob- 
ley, Morrilton,  and  A.  L.  Mobley,  Albu- 
querque, N.  M. 


G.  I.  JACKSON,  aged  58,  died  at  Ever- 
ton,  September  13th.  He  had  practiced 
in  Boone  County  for  32  years,  the  last 
several  years  at  Harrison.  He  is  survived 
by  his  wife;  two  sons,  Drs.  Ulys  Jackson 
and  Lloyd  Jackson,  his  associates  in  prac- 
tice, and  three  daughters. 


84 


THE  JOURNAL  OF  TH  E 


[Vol.  XXXI,  No.  5 


WOMAN’S  AUXILIARY  PAGE 


MRS.  WILLIAM  HIBBITTS,  Texarkana, 

President,  Woman’s  Auxiliary  to  the  Arkansas 
Medical  Society  1934-1935. 


Mrs.  William  Hibbittis,  Texarkana,  tenth  pres- 
ident of  the  Arkansas  Medical  Auxiliary  was 
born  in  Texarkana.  Before  her  marriage  she 
was  Katherine  McCartney,  and  is  a descendant 
of  a long  line  of  distinguished  physicians.  She 
attended  the  public  schools  in  Texarkana,  then 
went  to  Saint  Mary’s  College,  Dallas,  where  she 
graduated.  After  this  Mrs.  Hibbitts  spent  three 
years  at  the  New  England  Conservatory,  Bos- 
ton, where  she  specialized  in  organ  and  piano. 

Mrs.  Hibbitts  has  served  as  president  of  the 
Bowie-Miller  County  Auxiliary  and  as  parlia- 
mentarian and  vice-president  of  the  Arkansas 
Auxiliary.  As  the  Texarkana  Auxiliary  works 
in  both  Texas  and  Arkansas  she  has  served  as 
vice-president  of  the  Texas  Auxiliary,  and  has 
twice  been  the  president  of  the  Northeast  Texas 
Auxiliary. 

Mrs.  Hibbitts  has  many  other  interests,  hav- 
ing served  the  Presbyterian  church  for  many 
years  as  organist  and  choir  director,  is  a mem- 
ber of  the  Junior  League,  the  Garden  Club,  and 
is  president  of  the  Texarkana  Community  Coun- 
cil of  Girl  Scouts.  For  the  past  two  years  she 


has  served  the  women’s  division  of  the  Com- 
munity Chest,  and  is  vice-president  of  the  Hotel 
McCartney  Company.  Her  special  interest  is 
music  and  she  is  a member  of  the  Arkansas 
Chapter  of  the  American  Guild  of  Organists.  Each 
year  she  gives  an  organ  recital  in  Texarkana. 

Mrs.  Hibbitts’  husband,  son  and  daughter  are 
very  much  interested  in  all  her  activities  and 
she  says  that  it  is  only  with  their  help  and  co- 
operation that  she  can  accomplish  so  much. 


Dear  Auxiliary  Members: 

The  long,  hot  summer  days  are  behind  us,  and 
I hope  that  with  the  coming  of  cooler  weather 
you  will  all  have  a renewed  interest  in  your 
Auxiliary  work.  There  is  so  much  to  be  ac- 
complished this  year,  and  there  are  only  seven 
months  before  our  annual  meeting. 

This  year  we  hope  to  stress  public  relations, 
physical  examinations  for  every  doctor’s  wife, 
and  self-education. 

I hope  that  each  Auxiliary  will  have  at  least 
one  public  relations  meeting  this  year  in  order 
that  your  community  may  have  the  opportunity 
to  hear  a well-informed  speaker  talk  on  some 
health  subject.  Everyone  is  interested  in  health 
for  themselves  and  their  community,  and  I am 
sure  that  the  public  will  welcome  such  a meet- 
ing sponsored  by  your  Auxiliary. 

I do  hope  that  each  of  you  are  keeping  in  con- 
tact with  all  local  organizations  who  have  health 
and  educational  programs.  Be  prepared  and 
willing  to  assume  leadership  in  such  programs 
in  order  that  they  may  be  directed  along  the 
lines  our  doctors  advocate. 

In  order  that  we  may  help  others  with  their 
health  problems,  we  must  first  be  well  informed 
ourselves.  Read  Hygeia  and  have  programs  pre- 
pared from  some  of  the  health  pamphlets  which 
the  American  Medical  Association  approves. 
Study  about  some  of  the  various  problems  which 
are  confronting  the  medical  profession.  Be  pre- 
pared to  uphold  the  ideals  of  your  husband’s  pro- 
fession ! 

While  we  are  helping  others,  do  not  forget  to 
help  yourself.  A physical  examination  will  be 
of  great  benefit  to  you.  Go  at  least  half-way 
to  meet  your  health  problem,  and  you  will  be 
richly  rewarded  by  knowing  the  true  condition 
of  your  body. 

I am  ready  and  willing  at  all  times  to  serve 
you.  If  you  will  only  call  on  me,  I shall  do  my 
best  to  help  you  with  any  Auxiliary  problem. 

Mrs.  William  Hibbitts,  President. 


The  Woman’s  Auxiliary  to  the  Arkansas  Med- 
ical Society  mourns  the  death  of  Mrs.  R.  R. 
Kirkpatrick,  our  State  Auxiliary  Treasurer, 
which  occurred  in  Texarkana  on  July  20th. 

We  have  suffered  the  loss  of  a member  whose 
rare  ability  and  charming  personality  endeared 
her  to  every  one  who  knew  her. 

Our  heartfelt  sympathy  to  her  bereaved  fam- 
ily and  to  the  Bowie  and  Miller  County  Auxiliary. 


October,  1934]  ARKANSAS  MEDICAL  SOCIETY 


85 


Book  Reviews 


Surgery  of  a General  Practice.  By  Arthur  E. 
Hertzler,  M.  D.,  and  Victor  E.  Chesky,  M.  D. 
With  472  illustrations.  St.  Louis.  The  C.  V. 
Mosby  Company.  1934.  Price  $10.00. 

This  book  is  based  upon  the  last  edition  of  the 
author’s  Minor  Surgery  published  in  1930.  Some 
chapters,  as  that  on  bandaging,  have  been  cur- 
tailed to  make  room  for  needed  additions,  and 
the  whole  has  been  enriched  with  some  472  tech- 
nically excellent  illustrations.  The  plea  is  made 
for  the  return  of  the  general  practitioner  as  a 
means  of  warding  off  state  medicine,  by  making 
available  to  him  relatively  simple  procedures 
formerly  associated  with  elaborate  hospitaliza- 
tion, multiple  assistants,  and  high  cost  of  medi- 
cal care. 

The  material  is  taken  up  under  three  parts, 
namely:  special  surgery,  regional  surgery  and 
general  surgical  therapeutics.  In  each  instance 
one  method  is  presented  which  the  authors  have 
found  to  be  practicable,  together  with  a few  sim- 
ple diagnostic  points  making  for  the  recognition 
of  lesions  in  their  beginnings  rather  than  after 
becoming  so  extensive  as  to  demand  heroic  pro- 
cedures. 

This  book  should  make  a special  appeal  to  the 
interne  and  embryo  practitioner  of  medicine,  of- 
fering as  it  does  a transition  from  the  marble 
halls  of  theory  to  the  stern  realities  of  practical 
application.  On  the  other  hand,  the  wealth  of 
information  makes  it  an  invaluable  reference  for 
the  general  practitioner  as  well  as  the  surgeon. 
The  authors’  treatment  of  sciatica,  for  instance, 
should  prove  popular  to  those  so  frequently  called 
upon  to  treat  this  bete  noir  of  medicine. 

Above  all  the  work  is  written  in  the  inimita- 
ble “Hertzlerian”  style,  making  it  very  readable 
as  well  as  enjoyable. — F.  H.  K. 


Materia  Medica,  Pharmacology  and  Therapeu- 
tics. By  Walter  A.  Bastedo,  M.  D.,  Sc.  D.,  F.  A. 
C.  P.  Assistant  Clinical  Professor  of  Medicine, 
Columbia  University.  Consulting  Physician,  St. 
Luke’s  Hospital,  New  York,  St.  Vincent’s  Hos- 
pital, Staten  Island  and  the  Staten  Island  Hos- 
pital. President,  United  States  Pharmacopeil 
Convention  1930-1940.  Member  of  the  Revision 


Committee  U.  S.  Pharmacopeia.  Pp.  739.  Price 
$6.50.  W.  B.  Saunders  and  Company,  1932. 

This  volume  not  only  deals  with  the  pharmo- 
cologic  action  of  the  various  drugs  in  a most 
complete  manner  but  also  takes  up  their  chemical 
structure  and  mode  of  action.  Besides  its  com- 
pleteness in  discussing  the  qualities  and  actions 
of  the  various  drugs,  it  also  treats  of  the  physi- 
ology of  the  body  in  its  entirety  and  correlates 
this  physiologic  function  with  the  pharmacologi- 
cal action  of  the  drug  thus  giving  the  why  of  the 
use  of  the  drug  and  not  merely  advising  the  use 
of  the  drug  as  is  so  often  done. 

In  each  section  after  the  physiology  of  the  part 
has  been  explained  and  discussed  in  detail,  both 
from  a normal  and  abnormal  point  of  view,  the 
action  of  the  various  drugs  on  this  part  is  dis- 
cussed and  the  dosage  and  indications  for  the  use 
of  the  drug  given.  Supplementary  treatment  and 
alternatives  are  also  treated  at  length. 

This  book  is  complete  in  its  scope,  logically  and 
completely  indexed.  It  should  be  a valuable  ad- 
dition to  any  medical  library. — T.  P.  F. 

Infant  Nutrition.  By  W.  McKim  Marriott,  M. 
D.,  Professor  of  Pediatrics,  Washington  Univer- 
sity School  of  Medicine,  Saint  Louis.  Pp.  350 
with  50  illustrations.  Price  $5.50.  Saint  Louis: 
C.  V.  Mosby  Company,  1933. 

Here  one  finds  a truly  scientific  discussion  of 
infant  feeding  debunked  of  fadism  and  folklore. 
The  author  discusses  just  enough  of  physiology 
to  cover  known  facts  of  digestion,  leaving  theo- 
ries for  the  'larger  books.  The  modifying  of 
cow’s  milk  for  the  bottle  fed  normal  baby,  with 
the  sugar  additions  are  most  plainly  explained. 
The  much  needed  emphasis  of  the  longer  time 
interval  is  well  stated.  The  supposed  marvelous 
advantages  of  special  infant  foods  and  individual 
“brands”  are  well  handled  and  placed  where  they 
have  long  rightfully  belonged.  Special  feedings 
for  special  diseases  and  the  reasons  therefor  are 
clearly  stated. 

Both  student  and  practitioner  can  here  find, 
in  a brief,  concise  and  practical  form  just  what 
he  needs,  without  wading  through  a mass  of 
theory  and  quotation,  at  the  same  time  knowing 
full  well  that  the  decision  reached  is  the  result 
of  the  many  and  vast  experiences  of  a great  clini- 
cian and  teacher. — S.  J.  W. 


Granite  Mountain  Hospital 

Open  to  All  Reputable  Physicians  and  Surgeons 
S.  P.  JUNKIN,  M.  D.,  Medical  Director 
Telephone  Rural  9579-F2  Route  4,  Little  Rock,  Ark. 


J.  L.  Harris 

LITTLE  ROCK  ARTIFICIAL 


Roe  McCranie 

LIMB  CO. 


The  Old  Reliable  Firm 
521  1-2  Main  Street 


LIMBS  AND  BRACES 

Phone  5979 


Same  Location  Since  1911 

Little  Rock,  Ark. 


If  KARO  cost 

$1  per  pound 


it  would  be  well  worth  it 
for  feeding  babies 


KARO  has  gained  its  wide  popularity  in  infant 
feeding,  not  because  of  its  low  cost,  but  because  of 
its  suitability.  It  has  stood  the  test  of  clinical  experi- 
ence for  over  fifteen  years. 


Karo  Syrups  are  essentially  Dextrins,  Maltose  and 
Dextrose,  with  a small  percentage  of  Sucrose  added 
for  flavor— all  recommended  for  ease  of  digestion  and 
energy  value. 


To  further  aid  the  medical  profession,  the  makers 
of  Karo  are  now  prepared  to  offer  this  product  in 
dry,  powdered  form. 

Karo  powdered  is  a spray  dried,  refined  corn  syrup, 
composed  essentially  of  Dextrins,  Maltose  and  Dex- 
trose in  proportions  approximating  those  in  Karo  Syrup. 

For  Further  Information  Write  to: 

CORN  PRODUCTS  REFINING  COMPANY 

17  BATTERY  PLACE  ~ NEW  YORK  CITY 


The  ‘Accepted’  Seal  denotes  that  Karo  and  advertisements  for  it  are  ac- 
ceptabletothe  Committee  on  Foods  of  theAmerican  Medical  Association. 


The  Council  urges  support  of  JOURNAL  advertisers. 


T F 

CODE 

IE  J O U R N A 

of  the  ARKANSAS  MEDICAL  SOCIETY 

PUBLISHED  MONTHLY  UNDER  DIRECTION  OF  THE  COUNCIL 

L L 

CODE 

Vol.  XXXI 

Fort  Smith,  Arkansas,  November,  1934 

No.  6 

CORONARY  THROMBOSIS* 

Roy. I.  Millard,  M.  D. 

Dardanelle 

Coronary  Thrombosis  is  the  term  usual- 
ly employed  to  designate  occlusion  of  one 
or  more  branches  of  the  coronary  arteries. 
Embolism  is  rarely  a factor,  the  usual  con- 
dition being  the  formation  of  a thrombus 
at  the  site  of  an  atheroma. 

The  disease  is  most  commonly  found  in 
the  fifth  decade,  males  being  more  fre- 
quently affected,  about  nine  to  one.  It 
was  formerly  believed  that  tobacco,  alco- 
hol, occupation,  and  social  status  were  im- 
portant factors  in  the  production  of  coro- 
nary occlusion,  but  more  recent  observa- 
tions indicate  that  the  importance  of  these 
has  been  overestimated.  However,  arteri- 
osclerosis is  the  principal  predisposing  fac- 
tor. More  or  less  coronary  sclerosis  may 
be  present  without  marked  generalized 
“hardening  of  the  arteries,”  just  as  the 
renal  vessels,  or  the  cerebral,  may  be  the 
seat  of  marked  arteriosclerosis  without 
demonstrable  atheromata  in  the  peripheral 
vessels.  The  precipitating  causes  of  an 
attack  may  be  undue  physical  or  emotional 
strain  or  dietary  indiscretion. 

The  pathology  is  that  of  coronary  scler- 
osis and  infarction  in  the  area  of  heart 
muscle  supplied  by  the  occluded  vessel. 
The  infarcted  area  varies  according  to  the 
size  of  the  affected  artery.  There  may  be 
numerous  small  patches  in  which  scar  tis- 
sue has  replaced  the  muscle  or  there  may 
be  large  soft  areas,  an  aneurysm,  or  even 
a rupture  of  the  heart  muscle.  Contrary 
to  former  belief  not  all  coronary  arteries 
are’ terminal  branches,  hence  some  collater- 
al circulation  may  soon  be  established,  the 
extent  of  necrosis  varying  in  inverse  pro- 
portion to  the  amount  of  collateral  circu- 


* — Read  before  the  Fifty-ninth  annual  session 
of  the  Arkansas  Medical  Society  held  at  Little 
Rock  April  16-18,  1934. 


lation.  There  is  an  anatomical  narrowing 
in  the  anterior  branch  of  the  left  coronary 
artery,  making  this  a common  location  for 
the  formation  of  a thrombus.  The  area 
of  softening  assumes  the  form  of  a pyra- 
mid with  the  base  toward  the  apex  of  the 
heart,  and  the  greatest  softening  near  the 
endocardium.  A sterile  fibrinous  pericar- 
ditis is  associated. 

The  onset  of  an  attack  of  coronary  oc- 
clusion is  usually  sudden.  The  patient  is 
often  a man  between  50  and  60  who  has 
always  been  active  and  in  good  health.  He 
may  give  a history  of  some  previous  mild 
attacks  of  “indigestion,”  but  he  states  that 
he  has  never  had  a pain  like  this.  The  at- 
tack may  come  on  after  a full  meal  or  dur- 
ing sound  sleep.  The  pain  is  severe  and 
agonizing,  and  may  be  stabbing,  burrow- 
ing, or  gripping  in  character.  It  is  often 
so  severe  that  it  is  not  relieved  by  one  half- 
grain of  morphine.  It  may  be  in  the  epi- 
gastrium, in  the  region  of  the  heart,  or 
deep  beneath  the  sternum.  It  may  be  con- 
fined to  one  spot,  or  it  may  be  referred  to 
the  right  or  left  shoulder  or  both.  There 
is  a profound  sense  of  apprehension  and 
often  a tingling  sensation  along  the  left 
arm  and  even  in  the  fingers.  Shock  is 
pronounced  and  is  manifested  by  great 
prostration,  fall  in  blood  pressure,  and  a 
cold,  clammy  skin.  The  patient  appears 
desperately  ill,  is  restless,  tosses  about  and 
thinks  he  is  going  to  die.  The  face  is 
pinched  and  drawn,  and  there  is  a pecu- 
liar, ashy-gray  appearance  of  the  skin. 
Breathing  is  labored  and  often  of  the 
Cheyne-Stokes  type,  and  there  is  cyanosis 
of  the  lips  and  fingers. 

Examination  at  this  time  may  not  re- 
veal enough  cardiac  signs  to  account  for 
the  desperate  symptoms.  The  pulse  may 
be  slow,  and,  if  seen  early  in  the  attack, 
the  blood  pressure  may  not  have  fallen  as 
much  as  it  will  later.  The  heart  sounds 
have  a feeble  far-away  sound,  and  there 
may  be  a slight  gallop  rhythm.  However, 


88 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  6 


signs  of  myocardial  infarcation  and  re- 
sulting insufficiency  develop  if  the  pa- 
tient survives  for  6 to  10  hours.  There 
is  fever  99  to  101  and  leukocytosis  be- 
tween 10,000  and  20,000.  The  pulse  be- 
comes rapid  and  often  irregular,  and  the 
blood  pressure  drops  rapidly,  sometimes  to 
an  alarming  figure.  Passive  congestion  is 
manifested  by  rales  in  the  bases  of  the 
lungs,  albuminuria,  hepatic  enlargement, 
and  slight  subcutaneous  edema.  At  this 
time  a slight  to  and  fro  pericardial  fric- 
tion rub  may  be  heard,  and  is  almost  pa- 
thognomonic, although  its  absence  does 
not  mean  that  there  is  no  occlusion.  Gas- 
trointestinal symptoms,  nausea,  vomiting, 
diarrhea,  abdominal  distention,  are  often 
prominent,  and  may  mislead  the  physician 
or  surgeon  into  a diagnosis  of  an  acute 
upper  abdominal  surgical  emergency. 

Clinically  the  patient  will  fall  into  one 
of  three  groups.  In  the  first  group  death 
is  instantaneous  or  occurs  in  a few  min- 
utes or  a few  hours  at  most.  It  was  for- 
merly believed  that  all  cases  of  coronary 
thrombosis  were  of  this  type.  In  the  sec- 
ond group  are  found  patients  who  survive 
the  initial  attack  for  several  hours,  days 
or  weeks,  and  then  die  from  ruptured  car- 
diac aneurysm  or  myocardial  insufficien- 
cy. In  these  cases  the  pain  continues,  the 
pulse  is  rapid,  the  blood  pressure  con- 
tinues low,  cyanosis  increases,  passive  con- 
gestion becomes  marked  and  the  heart 
muscle  fails  to  respond  to  digitalis  or  any 
other  therapy.  The  third  group  compris- 
es those  cases  who  recover  and  are  able 
to  live  restricted  lives  for  variable  periods 
of  time. 

Coronary  thrombosis  should  be  suspect- 
ed in  any  man  past  40  or  45  who  has  a 
sudden  attack  of  pain  in  the  chest  or  epi- 
gastrium, with  a sense  of  constriction. 
Aids  in  diagnosis  are  severe  pain,  appre- 
hension, dyspnea,  shock,  anxious  facies, 
mild  fever  and  leukocytosis,  and  a drop  in 
blood  pressure.  The  electro-cardiogram  is 
of  value  in  a doubtful  case,  as  is  the  X- 
ray.  Zadek  has  pointed  out  that  in  over 
50  per  cent  of  cases  there  is  a characteris- 
tic bulging  along  the  left  ventricle  in  the 
roentgenogram.  However,  it  should  be 
borne  in  mind  that,  although  these  proce- 
dures may  be  of  value  in  some  doubtful 
cases,  the  majority  of  cases  of  coronary 


occlusion  are  acutely  sick,  and  should  be 
diagnosed  and  treated  where  they  are 
found. 

The  clinician  must  differentiate  angina 
pectoris,  valvular  heart  disease,  luetic  aor- 
titis, and  acute  abdominal  accidents.  In 
angina  pectoris  the  pain  comes  on  sud- 
denly, but  usually  after  effort,  is  of  the 
same  violent,  agonizing  type,  and  is  asso- 
ciated with  the  same  sense  of  impending 
disaster.  However,  there  is  no  dyspnea 
and  cyanosis,  and  the  blood  pressure  often 
rises.  The  attack  is  usually  relieved  by 
rest  and  the  nitrites,  and  increased  effort 
may  precipitate  another  attack.  On  the 
other  hand,  rest,  the  nitrites,  and  some- 
times even  morphine  in  large  doses  fail  to 
relieve  the  patient  with  occlusion.  Not 
infrequently  attacks  of  thrombosis  are  pre- 
ceded by  several  years  of  angina  pectoris. 
The  change  is  recognized  by  the  fact  that 
the  attacks  come  on  without  effort,  even 
while  lying  in  bed,  last  longer,  are  accom- 
panied by  dyspnea  and  cyanosis  and  are 
not  relieved  by  measures  which  usually  re- 
lieve angina  pectoris.  Valvular  heart  dis- 
ease and  leutic  aortitis  often  occur  at  a 
somewhat  younger  age,  may  give  a rheu- 
matic or  leutic  history,  and  do  not  pro- 
duce the  severe,  agonizing  pain  so  charac- 
teristic of  occlusion.  Physical  examina- 
tion will  reveal  these  two  conditions.  Per- 
forated gall  bladder  or  peptic  ulcer,  gall 
stone  colic,  or  acute  pancreatitis  may  simu- 
late coronary  thrombosis,  as  any  of  these 
conditions  may  produce  pain  in  the  epi- 
gastrium or  near  the  ensiform  process, 
nausea,  vomiting,  upper  abdominal  rigid- 
ity, and  collapse.  The  history  should  be 
minutely  complete  in  regard  to  symptoms 
preceding  any  of  these  surgical  emergen- 
cies, and  may  shed  some  light.  Particu- 
lar attention  should  be  paid  to  a history 
of  breathlessness  or  of  shooting  pains  in 
the  chest.  The  abdominal  rigidity  often 
found  in  coronary  thrombosis  may  be  dif- 
ferentiated from  that  associated  with  peri- 
toneal irritation  by  the  fact  that  in  the 
latter  the  patient  breathes  only  with  the 
upper  thoracic  muscles,  limiting  motion  of 
the  lower  part  of  the  thorax  as  much  as 
possible,  while  in  the  former  condition  the 
desperate  need  for  oxygen  calls  into  play 
every  possible  respiratory  effort,  and  the 
excursions  of  the  lower  portion  of  the 
thorax  are  wide.  A careful  examination 


November,  1934]  ARKANSAS  MEDICAL  SOCIETY 


89 


of  the  bases  of  the  lungs  posteriorly  will 
often  reveal  rales  very  early  and  thus 
point  to  thrombosis  with  accompanying 
myocardial  damage. 

The  outlook  for  one  who  has  been  the 
victim  of  an  attack  of  coronary  thrombo- 
sis is  very  uncertain.  This  disease  is  com- 
mon among  physicians  and  this  very  un- 
certainty and  dread  is  one  of  the  most 
unpleasant  features  of  the  disease.  He 
may  recover  from  a severe  attack  only  to 
succumb  shortly  to  what  at  first  appears 
to  be  a mild  attack.  He  may  live  a re- 
stricted life  for  several  years,  and  die  from 
some  other  cause,  or  recover  sufficiently 
to  lead  fairly  active  life  for  a number  of 
years.  The  age  of  onset  does  not  material- 
ly influence  the  outlook. 

As  soon  as  the  patient  is  seen  and  the 
condition  suspected  he  should  receive  one 
half-grain  of  morphine.  This  may  be  re- 
peated in  a half  hour  if  necessary.  This 
may  be  a life-saving  procedure.  Certainly 
it  lessens  the  pain  and  to  a certain  extent 
allays  the  apprehension  of  the  patient.  It 
is  also  of  great  value  in  counteracting 
shock.  The  patient  must  be  kept  absolute- 
ly in  bed  under  the  care  of  a competent 
nurse.  A lightly  filled  ice  cap  on  the  pre- 
cordium  may  be  comforting,  but  if  the  pa- 
tient objects  it  should  be  removed.  Every- 
thing possible  should  be  done  to  keep  the 
sufferer  mentally  and  physically  at  rest. 
Small  enemata  are  preferable  to  any  lax- 
ative for  the  constipation  that  is  likely  to 
be  present. 

As  soon  as  possible  after  the  onset  of 
an  attack  the  patient  should  receive  .12 
grams  of  aminophyllin  in  10  cc.  of  dis- 
tilled water  intravenously.  Warnings  have 
been  issued  against  the  use  of  this  or  any 
other  vaso-dilator  in  the  presence  of  low 
blood  pressure.  The  writer  has  given  .24 
grams,  carefully  recording  the  pressure 
before,  during,  immediately  after,  and  one 
hour  after  the  administration,  in  a num- 
ber of  injections,  with  the  pressure,  in 
various  patients,  ranging  from  90  to  160 
systolic,  and  has  not  noted  any  apprecia- 
ble fall  in  the  pressure  that  could  be  at- 
tributed to  the  drug.  On  the  other  hand 
the  patient  immediately  experiences  a sen- 
sation of  warmth,  seems  to  feel  relaxed, 
and  is  able  to  breathe  more  freely  because 
the  terrible  sense  of  constriction  in  the 


chest  is  relieved.  This  drug  is  especially 
appreciated  by  those  patients  whose  pain 
is  not  relieved  by  morphine,  the  cases  of 
so-called  status  anginosus.  Aminophyllin 
should  be  administered  very  slowly  and  the 
patient  told  that  he  will  probably  feel  a 
flushing  of  the  skin.  The  dose  of  .12  to  .24 
grams  should  be  repeated  every  4 to  12 
hours,  depending  upon  the  response.  It 
acts  as  a potent  vaso-dilator  on  renal  and 
coronary  vessels,  producing  a needed  diu- 
resis, and  perhaps  improves  the  coronary 
circulation,  thus  relieving  to  a certain  ex- 
tent the  myocardial  anoxemia,  which  is 
thought  to  be  a big  factor  in  the  produc- 
tion of  pain. 

This  preparation  may  be  given  intra- 
muscularly, .24  to  .48  grams  in  2 cc.  of 
water,  but  its  action  is  slower  and  it  pro- 
duces a great  deal  of  local  pain  and  sore- 
ness. It  is  also  available  in  tablets  and 
suppositories.  Thus  it  may  be  used  after 
the  emergency  has  passed  if  there  still 
seems  to  be  some  need  of  further  vaso-di- 
lation.  However,  it  is  in  the  emergency 
that  this  drug  is  of  most  value,  and  the 
continued  exhibition  of  so  potent  a vaso- 
dilator is  open  to  question. 

Absolute  rest  in  bed  should  be  insisted 
upon  for  a variable  length  of  time,  de- 
pending upon  the  clinical  condition.  No 
hard  and  fast  rule  can  be  laid  down  in 
regard  to  the  length  of  time  in  bed  after 
the  patient  begins  to  feel  relieved.  Six 
weeks  has  often  been  mentioned,  and 
probably  no  case  should  be  up  in  less  time, 
but  some  will  require  much  longer.  Activ- 
ity should  be  resumed  very  cautiously,  for 
the  test  of  function  will  give  more  informa- 
tion in  regard  to  the  condition  of  the  myo- 
cardium than  any  clinical  or  laboratory 
procedure. 

As  soon  as  possible  the  patient  should 
be  digitalized.  This  procedure  is  the  best 
protection  against  the  almost  inevitable 
passive  congestion.  Some  investigators 
have  condemned  the  use  of  digitalis  in  the 
presence  of  coronary  sclerosis,  stating  that 
it  increases  coronary  constriction.  How- 
ever, 0.  Muller  and  his  associates  showed 
that  this  is  a toxic  effect  of  digitalis  and 
that  in  physiologic  doses  it  actually  in- 
creases coronary  circulation.  This  drug, 
in  maintenance  doses,  should  be  continued 
until  the  damaged  myocardium  has  re- 


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[Vol.  XXXI,  No.  6 


turned  as  nearly  as  possible  to  normal. 
The  only  actual  contra-indications  to  its 
use  are  idiosyncrasy  and  those  rare  cases 
in  which  the  lesion  is  so  situated  that  a 
partial  heart  block  is  produced. 

In  cases  of  extreme  ventricular  tachy- 
cardia large  doses  of  quinidine  sulphate, 
.6  to  one  gram  every  4 to  6 hours,  may  be 
life  saving.  During  the  administration 
of  this  drug  the  patient  must  be  watched 
very  carefully,  although  there  is  less  dan- 
ger in  this  type  of  case  than  in  old  fibril- 
lating  hearts. 

In  cases  of  extreme  prostration  “Sym- 
natol,”  a derivative  of  adrenalin,  more  pro- 
longed in  action,  and  less  toxic,  is  recom- 
mended by  M.  Hochrrein.  Caffeine  sodio- 
benzoate  and  the  application  of  external 
heat  are  often  indicated.  The  accompany- 
ing nausea  is  sometimes  a very  distressing 
symptom,  not  being  relieved  by  vomiting. 
Gastric  lavage  is  absolutely  contra-indi- 
cated. Alcohol-sugar  mixtures  probably 
do  more  to  relieve  this  condition  than  any 
other  measure.  These  are  best  given  as 
one  ounce  of  equal  parts  of  aromatic  elixir 
and  grain  alcohol  in  cracked  ice  every  hour 
until  relieved.  Harlow  Brooks  believes 
that  our  former  position  in  regard  to  al- 
cohol in  some  forms  of  heart  disease  was 
based  on  a misconception,  and  that  instead 
of  being  harmful  it  may  be  of  distinct  ben- 
efit in  coronary  heart  disease. 

The  well  known  danger  of  coronary  at- 
tacks in  the  hypoglycemia  sometimes  as- 
sociated with  insulin  administration  has 
suggested  the  use  of  intravenous  glucose, 
especially  in  the  convalescent  stage.  This 
seems  to  improve  the  nourishment  of  the 
myocardium,  and  is  best  given  in  10  to  20 
cc.  doses  of  the  50  per  cent  solution,  re- 
peating every  few  hours  to  two  days  ac- 
cording to  the  judgment  of  the  clinician. 

While  considerable  space  has  been  de- 
voted to  drugs  that  are  of  value  in  the 
treatment  of  this  distressing  disease,  it 
must  be  borne  in  mind  that  they  do  not 
form  the  most  important  part  of  the  ther- 
apeutic regime.  Absolute  rest  and  quiet 
over  a long  period  of  time  are  essential. 
Pain  and  shock  must  be  controlled  by  the 
use  of  morphine  and  external  heat.  After 
convalescence  has  been  established  the  pa- 
tient’s diet  and  activities  should  be  super- 


vised. A soft,  nourishing,  easily  digesti- 
ble diet  with  plenty  of  carbohydrate  is  in- 
dicated. Work  and  play  are  to  be  regu- 
lated according  to  the  efficiency  of  the 
myocardium.  Prolonged  periods  of  work, 
especially  with  mental  concentration,  nerv- 
ous tension,  and  emotional  upsets  should 
be  guarded  against.  Frequent  vacations 
should  be  advised.  Obesity  should  be  con- 
trolled. Foci  of  infection  should  receive 
proper  attention.  If  the  patient  is  dia- 
betic insulin  should  be  administered  very 
cautiously. 

The  man  who  has  been  the  victim  of 
an  attack  of  coronary  thrombosis  should 
learn  to  avoid  excesses  in  work,  play,  eat- 
ing, nicotine,  caffeine,  and  alcohol.  If  the 
individual  has  been  an  habitual  user  of 
tobacco,  coffee  or  tea,  and  alcohol  these 
should  not  be  entirely  excluded,  but  the  pa- 
tient should  be  taught  the  importance  of 
moderation. 

<$> 

ABSTRACT 


Exner,  Max  J.  The  Darkfield  Diagnosis  of  Early 

Syphilis.  Med.  Times  and  Long  Island  Med. 

Jour.,  Aug.  1934,  62,  233-234. 

Early  diagnosis  and  treatment  of  syphilis  of- 
fers the  greatest  chance  for  its  arrest  or  cure 
in  the  shortest  time  and  for  preventing  the  de- 
velopment of  any  of  the  serious  consequences  of 
the  disease.  The  blood  test  does  not  serve  at  a 
time  when  the  diagnosis  is  of  greatest  advantage. 
The  darkfield  is  the  only  certain  method  of  diag- 
nosis in  the  sero-negative  stage,  a method  whose 
application  has  been  greatly  limited  by  the  neces- 
sity of  sending  the  patient  to  the  laboratory  for 
the  examination. 

Studies  made  by  the  Department  of  Health  of 
Ontario  have  demonstrated  the  feasibility  of 
transmitting  to  the  laboratory  by  mail  specimens 
suitable  for  darkfield  examination  and  this  serv- 
ice has  now  been  available  to  the  physicians  of 
New  York  state  for  two  years.  The  essential 
equipment  consists  of  two  or  three  capillary  tubes 
for  gathering  and  holding  the  fluid;  a vial  of 
half  and  half  mixture  of  vaseline  and  beeswax 
or  paraffin  for  sealing  the  ends  of  the  tubes;  a 
glass  tube  for  holding  the  capillary  tubes;  and  a 
mailing  container.  The  method  is  to  cleanse  and 
dry  the  lesion,  abrade  its  surface  with  a gauze 
sponge,  and  to  collect  the  exuded  serum  in  the 
capillary  tubes,  which  are  then  sealed  and  mailed 
to  the  laboratory.  While  simple,  the  technic  must 
be  followed  with  exactness. 

The  extreme  importance  of  diagnosis  of  syphilis 
in  the  early,  or  sero-negative  stage,  suggests  the 
urgency  of  a wider  adoption  of  this  darkfield 
service. 


November,  1934]  ARKANSAS  MEDICAL  SOCIETY  91 


ACUTE  ENCEPHALOMYELITIS  FOL- 
LOWING VACCINATION  AGAINST 
SMALL-POX:  CASE  REPORT 
WITH  A REVIEW  OF  THE 
LITERATURE* 

By  Walter  G.  Klugh,  M.  D. 
and 

Leon  E.  King,  M.  D. 

From  the  Department  of  Pediatrics, 
The  Leo  N.  Levi  Memorial  Hospital, 
Hot  Springs  National  Park,  Ark. 


With  rare  exceptions,  nearly  all  report- 
ed cases  of  acute  cerebro-spinal  disease 
complicating  anti-smallpox  vaccinations 
have  presented  such  clinical  and  patho- 
logical nervous  manifestions  as  to  lead  ob- 
servers to  designate  these  complications 
by  the  term  of  acute  encephalitis.  Such 
terms  as  Menigo-encephalitis  Syndrome, 
Myelitis,  (Spinal  Meningomyelitis)  and 
Acute  Disseminated  Myelitis  have  also 
been  used  to  designate  the  rarer  forms  of 
complications  following  anti-smallpox  vac- 
cinations. We  chose  the  term  Acute  En- 
cephalomyelitis as  most  suitable  to  ex- 
press the  various  clinical  nervous  manifes- 
tations presented  by  the  following  case: 

CASE  REPORT 

HISTORY : L.  M.,  a white  female  child,  aged 
6 years,  was  admitted  to  the  pediatric  service  of 
the  hospital  on  February  3,  1933.  She  was  vac- 
cinated for  the  first  time  by  the  County  Nurse 
on  January  20,  1933.  The  usual  accepted  vacci- 
nation procedure  was  used.  During  the  next 
eleven  days  the  patient  apparently  did  not  show 
any  signs  of  illness  except  that  the  reaction  to 
vaccination  was  so  severe  that  she  complained  of 
some  soreness  of  her  arm,  and  there  was  eleva- 
tion of  temperature.  Prior  to  her  present  illness 
she  had  been  quite  well,  except  for  an  occasional 
light  cold,  and  there  was  a history  of  the  child 
having  been  exposed  to  dampness  the  day  fol- 
lowing vaccination.  Her  past  history  was  essen- 
tially negative.  On  January  31,  1933,  eleven  days 
following  vaccination,  the  patient  became  ill,  vom- 
ited, and  complained  of  aching  in  her  back  and 
legs.  The  temperature  was  then  subnormal.  The 
following  day  she  developed  pyrexia  and  the  ach- 
ing continued,  involving  her  neck,  back,  and  lower 
extremities.  At  this  time  there  was  some  diffi- 
culty in  micturition  proceeding  to  retention.  No 
paralysis  had  been  noted  by  the  parents  previous 
to  the  child’s  admission  to  the  hospital.  There 
had  been  no  convulsions,  coma,  or  stupor  at  home. 


*— Reported  at  the  Clinical  Staff  meeting,  Leo 
N.  Levi  Memorial  Hospital,  April  6,  1933.  Sub- 
mitted for  publication  October  18,  1933. 


FINDINGS:  On  admission  the  child  had  a 
rectal  temperature  of  102°  F.;  pulse  110;  and 
respiration  26.  The  patient  appeared  acutely 
ill.  She  looked  apathetic,  somewhat  prostrated, 
and  rather  indifferent  to  attention.  Her  face  was 
flushed  and  intense  perspiration  was  noted  over 
her  back.  Her  breathing  was  somewhat  irregu- 
lar in  rate  and  intensity.  Examination  of  the 
ears,  eyes,  scalp,  nose  and  mouth  reevaled  nothing 
of  importance.  The  tonsils  were  large  hut  did 
not  appear  acutely  inflamed.  Neck  rigidity  was 
marked.  A few  coarse  dry  rales  were  audible 
throughout  the  chest.  Heart  findings  were  neg- 
ative except  for  the  increased  rate  and  sinus  ar- 
rhythmia. The  abdomen  was  distended  and  hy- 
pertympanitic.  The  most  notable  findings  were 
observed  upon  examination  of  the  lower  extremi- 
ties. There  was  flaccid  paralysis  of  both  lower 
extremities,  much  more  marked  on  left  than  on 
right,  with  severe  pain  attending  attempts  to  ac- 
tive and  passive  motion.  No  sensory  disturbances 
were  noted.  The  upper  and  right  lower  tendon 
reflexes  were  diminished  and  the  left  patellar  re- 
flex could  not  be  elicited.  Achilles  tendon  reflexes 
were  present.  Kernig’s  sign  was  absent.  No 
abdominal  reflexes  were  obtained.  Babinsky  and 
Oppenheim  signs  were  strongly  suggestive,  es- 
pecially on  the  left.  Definite  rigidity  of  the 
spinal  column  with  pain  on  motion  were  present. 
Urinary  retention  was  found.  There  was  evi- 
dence of  slight  paralytic  involvement  of  the 
phrayngeal  muscles  as  shown  by  some  difficulty 
in  deglutition  and  expectoration. 

LABORATORY  FINDINGS:  Urinalysis  was 
negative.  The  white  cell  count  was  16,266  of 
which  there  were  juveniles  10%;  segmented  65%; 
lymphocytes  21%;  and  monocytes  4%.  The  blood 
Wasserman  was  negative.  A spinal  puncture  was 
done  the  morning  following  admission.  The  fluid 
was  under  a moderately  increased  pressure  but 
appeared  entirely  clear.  The  microscopic  exami- 
nation of  the  fluid  revealed  50  cells  per  cubic 
mm.,  of  which  the  majority  were  lymphocytes;  the 
Wasserman  was  negative;  th  eglobulin  test  was 
strongly  positive. 

COURSE : The  patient  appeared  definitely  im- 
proved following  the  spinal  puncture.  She  was 
in  a more  receptive  mood,  complained  less  of  pain, 
and  the  vomiting,  which  had  persisted  through 
the  previous  night,  had  ceased.  The  improve- 
ment continued  through  the  next  day  when  the 
neck  rigidity  had  disappeared  and  patient  had 
made  some  successful  attempts  to  move  her  low- 
er extremities.  Howevei',  rectal  and  urinary 
sphincter  control  were  disordered.  Following  ad- 
mission her  temperature  promptly  dropped  and 
reached  a normal  level  on  the  fourth  day  of  her 
hospital  stay.  From  then  on  her  temperature 
remained  at  a practically  normal  level  through- 
out her  stay,  except  for  an  occasional  rise  to  be- 
tween 99°  and  99.8°.  Active  movement  of  her 
extremities  to  a satisfactory  degree  was  noted 
on  the  tenth  day  following  admission  and  the 
course  toward  complete  recovery  of  locomotor 
function  was  rapid.  The  recovery  from  rectal 
and  urinary  incontinence,  however,  was  delayed 


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[Vol.  XXXI,  No.  6 


for  another  ten  days.  Her  course  since  has  been 
uneventful  except  for  a persistent  urgency  and 
frequency  of  urination,  the  cause  of  which  has 
remained  obscure  in  spite  of  investigations  into 
the  function  of  the  urinary  tract.  The  abdominal 
reflexes  are  still  greatly  diminished  while  the 
deep  tendon  reflexes  are  somewhat  exaggerated. 
The  treatment  was  entirely  symptomatic.  For  a 
brief  period  she  received  small  doses  of  urotropin 
by  mouth. 

Review  of  the  Literature 
History 

The  post-vaccination  cerebro  - spinal 
complication  (encephalitis,  encephalomye- 
litis, etc.)  is  a relative  newly-recognized 
disease  entity  brought  to  the  attention  of 
the  medical  profession  as  recently  as  1924. 
Of  approximately  700  cases  that  have  been 
recognized,  only  71  have  been  recorded  in 
the  United  States  in  the  past  10  years.  By 
far  the  largest  number  of  reports  have 
come  from  Holland  and  England.  Numer- 
ous cases  have  also  been  recorded  in  Ger- 
many, Sweden,  and  Norway.  Occasional- 
ly, both  in  this  and  foreign  countries, 
small,  epidemic-like  outbreaks  have  occur- 
red, limiting  themselves,  however,  to  lo- 
calized areas  of  population.  The  compli- 
cations have  occurred  following  the  use  of 
both  rabbit-brain  virus,  guinea-pig  virus 
and  strains  of  calf  virus  obtained  from 
various  sources.  The  complications  have 
followed  both  single  and  multiple  inser- 
tion methods. 

Etiology 

The  specific  causative  agent  of  post- 
vaccination cerebro-spinal  disease  is  not 
definitely  known.  Several  theories  have 
been  advanced.  Chief  among  these  are: 

1.  That  the  vaccine  virus  itself  is  the 
causative  agent. 

2.  That  some  unknown  virus  becomes 
activated  by  the  vaccine  virus,  converting 
a latent  encephalitis  into  an  active  one. 

3.  That  the  disease  is  a manifestation 
of  an  anaphylatic  reaction,  the  vaccine  vi- 
rus acting  as  a sensitizing  agent  to  nerv- 
ous tissue. 

Other  theories  advanced  take  into  con- 
sideration vitamin  or  other  dietary  factor. 
Activation  by  vaccina  of  certain  forms  of 
bacteria,  especially  of  the  streptococci 
type,  and  of  certain  protozoa  and  yeasts 
have  also  been  suggested. 


Predisposing  Causes 

Post-vaccination  encephalitis  tends  to 
occur  more  in  rural  districts  than  in  cities ; 
girls  are  affected  more  often  than  boys. 
Infants  under  one  year  of  age,  though  not 
immune,  are  seldom  victims,  as  are  also 
children  over  eight  years  of  age.  The  lar- 
ger proportion  of  cases  have  occurred  fol- 
lowing the  primary  take  among  children 
of  school  age,  while  adolescents  and  adults 
are  practically  exempt. 

While  the  disease  has  occurred  both  fol- 
lowing multiple  and  single  insertions,  most 
students  of  the  subject  regard  the  former 
as  a greater  predisposing  method  than  the 
latter. 

Symptomatology 

The  nervous  manifestations  of  post-vac- 
cination encephalitis  are  quite  variable  and 
may  point  to  involvement  of  the  meninges, 
the  brain,  the  brain  stem,  the  spinal  cord, 
or,  as  most  frequently  encountered,  to  a 
combined  involvement  of  two  or  more  of 
these  structures.  In  spite  of  this  varia- 
bility of  clinical  symptoms,  the  disease  as 
a distinct  entity  has  been  firmly  estab- 
lished, mainly  on  the  basis  of  the  patho- 
logic post-mortem  findings,  which  are  dis- 
tinct and  characteristic. 

The  incubation  period  is  from  4 to  17 
days,  most  cases  developing  the  first 
symptoms  between  the  10th  and  13th  days 
following  vaccination.  The  uniformity  of 
onset,  course,  and  time  relations  of  the 
symptoms  in  most  cases  is  quite  striking. 
The  course  of  the  disease  is  rapid,  the  fatal 
cases  dying  on  the  third  or  fourth  day 
after  onset  of  symptoms,  or  two  weeks 
after  vaccination.  The  earliest  symptoms, 
as  described  by  H.  I.  Viets  and  S.  War- 
ren are:  “Headache,  vomiting,  pyrexia, 
and  a tendency  toward  paralysis.  In  in- 
fants convulsions,  too,  are  frequent.  Con- 
sciousness is  soon  lost.  The  paralysis  con- 
sists of  weakness  of  the  cranial  nerves  or 
of  the  extremities  and  there  is  consider- 
able variation  from  time  to  time.  The 
Babinski  response  is  sometimes  obtained. 
As  the  disease  progresses  the  deep  reflexes 
disappear.  Sphincter  control  is  usually 
disordered,  incontinence  being  a common 
finding.  Trismus  has  occurred  in  many 
cases.” 

The  spinal  fluid  is  clear,  often  in- 


November,  1934]  ARKANSAS  MEDICAL  SOCIETY 


93 


creased  in  pressure,  and  no  visible  or  cul- 
tivatable  organisms  can  be  demonstrated. 
The  cell  count  is  usually  increased,  con- 
taining mononuclear  and  polynuclear  cells. 
In  a few  cases  small  amounts  of  vaccine 
virus  were  detected.  On  the  other  hand, 
frequently  the  spinal  fluid  is  essentially 
negative. 

In  regards  to  the  diagnosis,  many  cases 
have  occasioned  much  confusion  and  have 
been  mistaken  for  tetanus,  epidemic  men- 
ingitis, tuberculous  meningitis,  encephali- 
tis lethargica,  meningismus,  poliomyelitis, 
cerebral  hemorrhage,  sunstroke,  epilepsy, 
and  hysteria.  In  differentiating,  the  his- 
tory, the  incubation  period,  course,  and 
symptoms  of  the  disease  as  well  as  the 
spinal  fluid  and  other  laboratory  findings 
are  essential  factors. 

Treatment 

Very  encouraging  results,  as  are  evi- 
denced by  recession  of  symptoms,  abate- 
ment of  the  course,  and  hastening  com- 
plete recovery,  have  been  reported  by  for- 
eign observers  following  the  use  of  serum 
or  citrated  blood  from  individuals  recent- 
ly vaccinated,  or  preferably,  vaccinated  at 
the  same  time  as  the  patient.  The  serum 
has  been  given  both  intrathecally  and  in- 
travenously, most  frequently  by  the  latter 
route.  Intravenously  it  has  been  given 
in  doses  of  from  8 to  10  cc.  for  one  or  two 
doses.  In  one  case  5 cc.  was  given  intra- 
thecally with  striking  results.  Very  good 
results  have  followed  this  treatment  in  se- 
vere cases  even  when  used  late,  such  as 
when  the  serum  was  given  to  four  days  fol- 
lowing onset  of  symptoms  or  13  to  16  days 
following  the  patient’s  vaccination.  One 
case  was  benefited  by  the  serum  of  the 
father  who  had  been  vaccinated  four  years 
before. 

The  simplicity  and  accessibility  of  this 
method  of  treatment  should  serve  to  en- 
courage its  trial  in  every  case. 

Prognosis 

Among  the  European  cases  the  mortal- 
ity rate  is  high,  occurring  in  50  per  cent 
of  the  cases  reported  in  England,  and  in 
35  per  cent  of  those  in  Holland.  The  mor- 
tality rate  in  this  country  has  been  esti- 
mated at  37  per  cent.  With  rare  excep- 
tions, the  non-fatal  cases  recover  prompt- 
ly and  completely,  leaving  no  sequelae.  Ex- 


ceptionally, residual  symptoms  persist,  a 
case  of  marked  mental  deterioration  and 
one  of  complete  flaccid  paralysis  of  both 
legs,  with  anesthesia  below  umbilical  level, 
having  been  reported  among  the  71  cases 
of  post-vaccination  encephalitis  in  this 
country. 

Prevention 

There  are  several  well  recognized  fac- 
tors in  considering  the  prophylaxis  of  this 
dreaded  post-vaccination  complication.  In- 
fancy may  be  considered  as  the  best  period 
to  subject  the  individual  to  the  primary 
vaccination,  preferably  during  the  first 
year  of  life.  This  should  always  be  done 
with  a suitable  technique,  one  of  which  is 
defined  by  Charles  Armstrong  as  “Em- 
ploying a small  superficial  insertion,  never 
over  one-eighth  inch  in  greatest  diameter 
and  which  employs  no  routine  dressing.” 
The  same  writer  on  the  basis  of  his  ex- 
periments with  mice  suggests  that  “inocu- 
lation with  diphtheria  toxoid  tends  to  ren- 
der these  animals  somewhat  more  resist- 
ant to  vaccine  virus  subsequently  adminis- 
tered intracerebrally.  It  is  suggested  that 
primary  vaccination,  especially  after  the 
first  year  of  life,  be  deferred  until  con- 
templated immunization  against  diphthe- 
ria or  other  diseases  by  means  of  inani- 
mate antigens  has  been  accomplished.” 

Nervous  children  or  those  with  neuro- 
logical ailments  should  be  excluded.  In 
times  when  encephalitis,  poliomyelitis  or 
meningococcus  meningitis  are  epidemic, 
vaccination  should  be  postponed.  Bed  rest 
for  three  weeks  following  vaccination  has 
also  been  suggested  as  a prophylactic 
measure. 

Pathology 

In  contrast  to  the  lack  of  uniformity 
in  the  clinical  symptoms  of  post-vaccina- 
tion encephalitis,  the  pathological  picture, 
especially  that  referable  to  the  microscopic 
examination,  is  constant,  characteristic, 
and  easily  differentiated  from  that  en- 
countered in  epidemic  encephalitis  (Le- 
thargic encephalitis)  or  in  poliomyelitis 
of  primary  origin;  on  the  other  hand  the 
findings  simulate  closely  those  occuring  in 
nervous  system  inflammations  complicat- 
ing such  diseases  as  measles  and  scarlet 
fever. 


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[Vol.  XXXI,  No.  6 


The  pathological  findings  are  fully  de- 
scribed by  H.  R.  Viets  and  S.  Warren,  who 
state,  in  part:  “The  gross  lesions  are  not 
at  all  distinctive,  consisting  chiefly  of  hy- 
peremia of  the  meninges,  some  edema  of 
the  brain,  and  at  times  punctate  spots  in 
the  brain  substance  due  to  dilated  vessels. 
The  microscopic  picture,  however,  is  dis- 
tinctive. The  outstanding  lesion  is  peri- 
vascular cellular  infiltration,  not  restrict- 
ed to  the  immediate  zone  of  the  vessels 
but  extending  some  little  distance  out  in- 
to the  brain  substance.  This  is  usually  ac- 
companied by  perivascular  demyeliniza- 
tion.  The  rapidity  with  which  the  demye- 
linization  appears  is  surprising,  having 
been  found  in  rare  cases  as  early  as  three 
days  after  onset  of  nervous  symptoms. 

“The  lesions  are  widespread  through- 
out the  brain  as  a rule,  tending  to  involve 
the  white  matter  rather  more  than  the 
gray.  The  more  acute  the  case,  the  more 
even  the  distribution.  The  lesions  may 
be  most  intense  in  the  region  of  the  pons 
and  the  upper  portion  of  the  medulla.  To- 
gether with  this  there  is  in  the  cord  a ten- 
dency toward  softening,  particularly  in 
the  lower  portion,  with  a partial  demye- 
linization  of  certain  fibers  there.” 

A detailed  histological  picture  may  be 
described  as  follows:  The  vessels,  particu- 
larly the  veins,  are  hyperemic  and  there 
is  an  infiltration  in  the  perivascular  space 
of  mononuclear  cells  and  polymorphonu- 
clear leukocytes  in  small  numbers.  There 
is  no  thrombosis  or  vasular  occlusion.  In 
the  extra-adventitial  tissue  there  is  infil- 
tration, becoming  more  diffuse  as  distance 
from  the  vessel  increases,  with  mononu- 
clear leukocytes,  lymphocytes  and  rare 
polymorphonuclear  leukocytes.  Together 
with  this  there  is  infiltration  of  microg- 
lia cells,  many  of  which  are  markedly  swol- 
len. With  ordinary  stains  there  is  seen 
to  be  a zone  of  rarefaction  surrounding  the 
vessels.  Special  staining  methods  reveal 
complete  disruption  of  the  myelin  sheaths 
and  rapid  disappearance  of  the  myelin  it- 
self in  these  zones,  while  not  infrequently 
the  axons  themselves  are  destroyed.  In 
the  adjacent  uninvolved  portions  of  the 
brain  the  nerve  fibers  and  their  myelin 
sheaths  can  be  readily  distinguished. 
There  is  much  less  involvement  of  the 
gray  matter  than  of  the  white  matter. 


Inclusion  bodies  have  not  been  found  in 
the  lesions.  In  many  cases  there  is  an  ac- 
companying meningitis.  The  subarachnoid 
space  is  distended  and  there  are  numerous 
large  mononuclear  leukocytes,  lymphocy- 
tes, and  occasional  polymorphonuclear 
leukocytes.  The  vessels  are  decidedly  hy- 
peremic and  dilated,  and  the  endothelial 
cells  of  their  walls  are  plump.  There  is 
not  infrequently  evidence  of  migration  of 
large  mononuclear  leukocytes  and  poly- 
morphonuclear leukocytes  through  the 
wall.” 

BIBLIOGRAPHY 

1.  Armstrong,  Charles,  Post-vaccination  En- 
cephalitis with  special  reference  to  prevention. 
Public  Health  Reports,  July,  1932,  Vol.  47,  No. 
30,  Pp.  1553-1567. 

2.  Viets,  Henry  R.  and  Warren,  Shields:  Vac- 
cinal Encephalitis,  The  New  England  Journal  of 
Medicine,  204:  475-481,  (March  5,  1931). 

/$. 

Coming  Medical  Meetings 


Inter-State  Post  Graduate  Medical  Association 
of  North  America,  Philadelphia,  November  5th 
to  9th. 

Southern  Medical  Association,  San  Antonio, 
November  13th  to  16th. 

Fourth  Councilor  District  Medical  Society,  Mon- 
ticello,  November  19th. 

Fort  Smith  Clinical  Society,  Fort  Smith,  No- 
vember 22nd. 

Third  Councilor  District  Medical  Society,  .Stutt- 
gart, November  27. 

Radiological  Society  of  North  America,  Mem- 
phis. December  3rd  to  7th. 

Ninth  Councilor  District  Medical  Society,  Har- 
rison, December  4th. 

Dallas  Southern  Clinical  Society,  Dallas,  March 
18th  to  25th,  1935. 

Arkansas  Medical  Society,  Fort  Smith,  April 
15,  16,  17,  1935. 

<i> 

QUININE  FORMULARY 


Merck  & Co.,  Inc.,  Rahway,  N.  J.,  has  issued 
a “Quinine  Formulary”  of  twenty-four  pages,  con- 
taining prescriptions  and  directions  for  using  qui- 
nine or  its  derivatives  in  thirty-eight  diseases  and 
conditions,  which  are  alphabetically  arranged,  be- 
ginning with  abortion  ( inevitable ),  running 
through  malaria,  and  ending  with  varicose  veins. 
It  contains  a bibliography  of  American  authori- 
ties giving  scientific  reasons  for  the  use  of  qui- 
nine in  the  conditions  that  are  mentioned.  The 
pamphlet  also  gives  the  uses  and  doses  of  the 
derivatives  of  quinine,  including  cupreine,  opto- 
chine,  and  quinidine,  which  have  specific  uses  in 
non-malarious  conditions. 

The  pamphlet  is  a compendium  of  valuable  in- 
formation, and  will  be  mailed  to  any  physician 
who  mentions  this  notice. 


November,  1934]  ARKANSAS  MEDICAL  SOCIETY 


95 


THE  JOURNAL 

OP  THE 

Arkansas  Medical  Society 


Owned  by  the  Arkansas  Medical  Society  and  Published 
under  direction  of  the  Council. 


DR.  W.  R.  BROOKSHER,  Editor 
610  First  National  Bank  Bldg.,  Fort  Smith,  Arkansas 


The  advertising  policy  of  this  Journal  is  governed  by 
the  rules  of  the  Council  on  Pharmacy  and  Chemistry  of 
the  American  Medical  Association. 

All  communications  to  this  Journal  must  be  made  to 
it  exclusively.  Communications  and  items  of  general 
interest  to  the  profession  are  invited  from  all  over  the 
State.  Notice  of  deaths,  removals  from  the  State, 
changes  of  location,  etc.,  are  requested. 


OFFICERS  OF  THE  ARKANSAS  MED1CAE  SOCIETY 


F.  O.  MAHONY,  President  ..  ....  El  Dorado 

M.  E.  McCASKILL,  Presidtnt-Elect  Little  Rock 

A.  M.  ELTON,  First  Vice-President  ...  . Newport 
S.  C.  FULMER,  Second  Vice-President  Little  Rock 
F.  D.  SMITH,  Third  Vice-President  . Blytheville 

R.  J.  CALCOTE.  Treasurer  Little  Rock 

W.  R.  BROOKSHER,  Secretary  ...  Fort  Smith 


COUNCILORS 

First  District — W.  M.  MAJORS  . _.  Paragould 

Second  District — S.  J.  ALLBRIGHT  Searcy 

Third  District — M.  C JOHN  . Stuttgart 

Fourth  District— C.  W.  DIXON  ...  . ...  Gould 

Fifth  District— L.  L.  PURTFOY  El  Dorado 

Sixth  District — DON  SMITH  Hope 

Seventh  District— GEO.  B.  FLETCHER  Hot  Springs 
Eighth  District — S.  B.  HINKLE  Little  Rock 

Ninth  District — D.  L.  OWENS  ..  Harrison 

Tenth  District — S.  J.  WOLFERMANN  Fort  Smith 


COMMITTEES  : 

(Appointments  expire  in  the  year  indicated.) 

Scientific  Work — L.  L.  Purifoy,  Chairman  ; El  Do- 
rado (1935)  : R.  B.  Robins,  Camden  (1936)  ; W.  R. 
Brooksher,  Fort  Smith  (1937). 

Medical  Legislation — Val  Parmley,  Chairman,  Little 
Rock  (1937)  ; M.  L.  Norwood,  Lockesburg  (1937)  ; O. 
L.  Williamson,  Marianna  (1937);  H.  T.  Smith,  Mc- 
Gehee  (1936)  : R.  L.  Smith,  Russellville  11936)  ; A.  S. 
Buchanan,  Prescott  (1935)  ; H.  A.  Dishongh,  Little 
Rock  (1935). 

Health  and  Public  Instruction — W.  B.  Grayson, 
Chairman,  Little  Rock  (1937)  ; S.  W.  Douglas,  Eu- 
dora  (1937)  ; B.  M.  Stevenson,  Crawfordsville  (1937)  ; 
H.  K.  Carrington,  Magnolia  (1936)  ; H.  A.  Stroud 
Jonesboro  (1936)  ; J.  H.  Fowler,  Harrison  (1935).  E. 
J.  Munn,  El  Dorado  (1935). 

Medical  Education  and  Hospitals — Joe  F.  Shuffield, 
Chairman,  Little  Rock  (1937)  : David  Levine,  El  Do- 
rado (1936)  ; J.  B.  Futrell,  Rector  (1935). 

Public  Relations — D.  A.  Rhinehart,  Chairman,  Lit- 
tle Rock  (1937)  ; E.  E.  Barlow,  Dermott  (1936)  ; M. 
E.  McCaskill,  Little  Rock  (1935). 

Medical  Economics — I.  F.  Jones,  Chairman,  Fort 
Smith  (1937)  ; R.  B.  Robins,  Camden  1937)  : J.  E. 
Neighbors.  Stuttgart  (1936)  ; D.  E.  White,  El  Dorado 
(1936):  Roy  Millard.  Dardanelle  (1935);  A.  C.  Shipp. 
Little  Rock  (1935)  ; R.  M.  Sloan,  Jonesboro  (1935). 

Scientific  Exhibit — F.  H.  Krock,  Chairman,  Fort 
Smith  (1935)  ; H.  King  Wade,  Hot  Springs  National 
Park  (1936)  ; W.  E.  Gray,  Jr.,  Little  Rock  (1937). 

Arrangements — (Host  Society  1935  meeting) — D.  W. 
Goldstein,  Chairman.  C.  S Holt,  J.  A Foltz.  H.  Moul- 
ton, M.  E.  Foster,  W.  G.  Elberle,  I.  F.  Jones. 

Necrology — W H.  Mock,  Chairman.  Prairie  Grove 
(1935)  ; J.  M.  Lemons,  Pine  Bluff  (1936)  ; H.  Moul- 
ton. Fort  Smith  (1937). 

Auxiliary— L.  J.  Kosminsky,  Chairman.  Texarkana 
(1935)  ; H.  T.  Wootton,  Hot  Springs  National  Park 
(1936)  ; C.  S.  Holt,  Fort  Smith  (1937). 

Cancer  Control — D.  W.  Goldstein,  Chairman,  Fort 
Smith  (1937)  ; R.  L.  Saxon,  Little  Rock  (1936)  ; L. 
A.  Purifoy,  El  Dorado  (1935). 


CORONARY  DISEASE 


Millard’s  article  in  this  issue  calls  at- 
tention to  the  significance  of  coronary  ar- 
tery disease,  a condition  which  has  re- 
ceived considerable  publicity  of  late  in 
the  lay  press  because  of  the  deaths  of 
several  prominent  persons  from  this 
cause. 

It  is  distinctly  an  affection  of  middle 
and  later  years  of  life,  rarely  acting  as  a 
cause  of  death  in  persons  under  35  years. 
Above  that  age,  however,  there  is  an  in- 
creasing frequency  of  the  disease. 

Willius1  has  reported  that  the  chief  cause 
of  the  condition,  sclerosis  of  the  arterial 
walls,  is  present  in  slight  degree  even  in 
the  first  decade  of  life  and  that  practical- 
ly all  individuals  are  affected  in  some  de- 
gree by  the  60th  year.  Other  coronary 
disturbances  may  be  due  to  dysfunction  of 
the  nerve  supply  to  the  arteries  resulting 
in  spasm  of  the  affected  vessel.  These 
changes  interfere  with  the  blood  supply 
of  the  cardiac  muscle,  anginal  pains  being 
the  usual  accompaniment  in  the  sclerotic 
type.  The  pain  usually  occurs  after  pro- 
longed exercise  but  may  follow  slight  exer- 
tion. Fortunately,  the  severity  of  the  pain 
enforces  rest  and  thus  assists  in  recovery. 
Thrombosis,  also  associated  with  the  scle- 
rotic type,  may  produce  death  without  pre- 
monitory symptoms. 

Largely  as  the  result  of  more  accurate 
diagnosis,  the  incidence  of  deaths  from 
this  disease  shows  a great  increase  in  re- 
cent years.  Sudden  deaths,  formerly  as- 
cribed to  “acute  indigestion’  ’and  the  like, 
are  now  known  to  be  due  to  coronary  ar- 
tery disease.  The  studies  of  Levy2,  how- 
ever, indicate  that  the  increase  is  an  ac- 
tual one.  For  this,  the  strenuousness  of 
modern  living  has  received  the  blame  but 
it  is  quite  likely  that  the  recorded  increase 
is  but  a part  of  the  general  ascent  in  car- 
dio-vascular  disease ; a morbidity  which  is, 
in  part,  inevitable,  due  to  the  declining 
mortality  of  infectious  diseases  and  length- 
ening of  the  average  life  span.  Coronary 
artery  disease  offers  a field  for  continued 
intensive  study  and  research. 

1 —  Willius,  P.  A.,  Smith,  H.  L.,  and  Sprague, 
P.  H.  Proc.  Staff  Meetings  Mayo  Clinic,  March 
1,  1933,  8,  140. 

2 —  Levy,  R.  L.,  Bruenn,  H.  G.,  and  Kurtz,  D. 
Amer.  Jour.  Med.  Sc.  March,  1934,  187,  376. 


96 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  6 


MEMBERSHIP 

The  roster  of  membership  of  the  Arkan- 
sas Medical  Society  as  printed  in  this  is- 
sue totals  1026  physicians,  an  increase 
over  the  880  of  1933  but  as  yet  far  from 
complete  in  listing  the  eligible  physicians 
of  the  state.  The  1934  Directory  of  the 
American  Medical  Association  gives  the 
records  of  1890  physicians  in  Arkansas,  a 
considerable  number  of  whom,  not  now 
members  of  this  Society,  are  eligible  for 
membership.  The  state  secretary’s  office 
is  now  compiling  a list  of  these  physicians 
by  counties  and  will  furnish  this  to  the 
respective  county  societies  in  the  near  fu- 
ture. It  is  to  be  hoped  that  the  county 
societies  will  exert  every  effort  to  secure 
the  affiliation  of  these  physicians,  thus 
strengthening  our  organization  for  mutual 
benefit. 

Medical  organization  must  represent  the 
greatest  possible  number  of  eligible  physi- 
cians. The  serious  problems  of  the  pres- 
ent day,  together  with  those  of  a govern- 
mental or  social  nature  which  may  devel- 
op, can  best  be  met  in  safety  and  security 
for  the  physician  only  if  the  profession 
is  in  a position  to  speak  and  act  as  a unit 
rather  than  as  a group  of  individuals. 
Each  member  of  the  Arkansas  Medical 
Society  may  increase  the  security  and  ben- 
efits of  our  medical  organization  by  his 
own  efforts  in  enlisting  every  eligible  phy- 
sician. 

<s> 

E.  R.  A.  MEDICAL  SERVICE 

Based  upon  comments  so  far  received 
from  the  membership  the  new  plan  of 
medical  service  for  persons  on  relief  rolls 
meets  with  general  approval.  This  is 
gratifying  to  the  committee  which  has 
worked  to  attain  the  present  objective. 
Every  member  of  the  Society  who  agrees 
to  give  service  under  this  plan  is  urged  to 
approach  the  county  relief  administrations 
on  a dignified,  conservative  basis  which 
will  reflect  credit  upon  the  organized  med- 
ical profession.  With  lay  persons  in 
charge  of  the  administration  it  is  to  be  ex- 
pected that  misunderstandings  will  arise 
from  time  to  time.  It  is  the  function  of 
the  county  advisory  committee  to  mini- 
mize the  friction  which  these  may  cause, 
handling  all  questions  referred  to  them 
promptly,  decisively  and  impartially.  The 


rendering  of  a professional  service  of  high 
quality  in  all  fairness  under  the  provisions 
of  this  plan  will  serve  to  increase  public 
confidence  in  the  right  of  medical  men  to 
lead  in  all  problems  of  health.  There  is 
need  for  physicians  to  view  this  problem, 
not  alone  in  the  light  of  medical  men  giv- 
ing service  to  the  indigent  and  receiving 
therefor  a small  allowance,  but  also  as 
citizens  vitally  concerned  with  the  entire 
problem  of  relief  activity. 

<8> 

Announcement 


The  Radiological  Society  of  North  America  will 
hold  its  next  annual  meeting  at  the  Hotel  Pea- 
body, Memphis,  Tennessee,  December  3-7,  1934. 
The  Medical  Profession  is  cordially  invited  to  at- 
tend. Further  information  may  be  obtained  by 
addressing  the  Secretary-Treasurer,  Dr.  Donald 
S.  Childs,  607  Medical  Arts  Building,  Syracuse, 
New  York. 


Obituary 


LOWE,  Walton  W.,  Gillett,  aged  60,  died 
September  16th.  He  was  a graduate  of 
the  Saint  Louis  University  School  of  Medi- 
cine and  had  practiced  in  Gillett  for  a 
number  of  years.  In  addition  to  follow- 
ing his  profession,  he  was  also  engaged  in 
rice  farming  and  was  a member  of  the  A. 
M.  Lowe  Drug  firm.  He  is  survived  by 
his  wife,  a son,  a daughter  and  two  broth- 
ers. 


ROBINSON,  Frank  C.,  Little  Rock,  aged 
71,  died  September  19th.  He  graduated 
from  the  Arkansas  Medical  College  in 
1896  and  had  practiced  in  Little  Rock 
since  1915.  He  is  survived  by  three  sis- 
ters. 


HARRISON,  A.  G.,  Searcy,  aged  58, 
died  at  a Memphis  Hospital  October  5th 
following  an  illness  of  two  years.  Dr.  Har- 
rison graduated  at  the  Memphis  Hospital 
Medical  College  in  1901  and  had  been  in 
practice  at  Searcy  for  many  years.  Dur- 
ing his  practice  there  he  founded  two  hos- 
pitals, the  Harrison  Hospital  being  under 
his  supervision  at  the  time  of  his  death. 
He  is  survived  by  his  wife  and  daughter, 
Miss  Marjorie. 


November,  1934]  ARKANSAS  MEDICAL  SOCIETY 


97 


Membership  Roster  of  the  Arkansas  Medical  Society,  1934 


ARKANSAS  COUNTYt 

Davis,  G.  C Gillett 

Dickens,  Homer DeWitt 

Drennen,  S.  A Stuttgart 

Fowler,  Arthur Humphrey 

John,  M.  C —.Stuttgart 

•Lowe,  W.  W Gillett 

Lumsden,  C.  A ....  .DeWitt 

Neighbors,  J.  E Stuttgart 

Park,  C.  E u DeWitt 

Poe,  Fielding  A St.  Louis,  Mo. 

Rasco,  C.  W DeWitt 

Riley,  H.  C Bayou  Meto 

Swindler,  E.  B Stuttgart 

Whitehead,  R.  H DeWitt 

Word,  James  T St.  Charles 

ASHLEY  COUNTYt 

Barnes,  L.  C ..Hamburg 

Coc'kerham,  H.  E Portland 

Cone,  A.  E.  Portland 

Crandall,  M.  C Wilmot 

Gibbs,  A.  M Hamburg 

Hawkins,  M.  C Parkdale 

Mask,  D.  L Hamburg 

•Norman,  W.  S Hamburg 

Simpson,  J.  W Hamburg 

Spivey,  C.  E Crossett 

White,  E.  O ..Hamburg 

Wood,  J.  T Crossett 

BAXTER  COUNTYt 

Appleby,  Scott Cotter 

Gray,  E.  M Mountain  Home 

Morrow,  J.  J ...  Cotter 

Tipton,  J.  T Mountain  Home 

Tipton,  W.  C New  Laguna,  N.  M. 


BENTON  COUNTY 


Atkinson,  R.  M 

Buffington,  G.  H 

Bentonville 

. Decatur 

Clemmer,  J.  L 

Gentry 

Crockett,  C.  S Lincoln 

Curry,  W.  J Rogers 

Duckworth,  F.  M Siloam  Springs 

Duncan,  M.  W Centerton 

Eubanks,  F.  G Decatur 

Greene,  L.  O Pea  Ridge 

Harrison,  A.  J Springdale 

Hodges,  G.  E Rogers 

Horton,  C.  W ...  Hiwasse 

Hughes,  G.  A Siloam  Springs 

Hurley,  C.  E Bentonville 

Koobs,  H.  J.  G Rogers 

Love,  Geo.  M Rogers 

McNeil,  Clyde  L Rogers 

Moore,  W.  A Rogers 

Peacock,  A.  L Gentry 

Pickens,  E.  A Bentonville 

Pickens,  W.  A. Bentonville 

Powell,  J.  T Gravette 

Scott,  L.  L Siloam  Springs 

Williams,  J.  R.__  . ^Siloam  Springs 
Wilson,  C.  S Siloam  Springs 

BOONE  COUNTYt 

Blackwood,  J.  C Harrison 

Evans,  D.  E Harrison 

Fowler,  J.  H Harrison 

Fowler,  T.  P Harrison 

Gladden,  J.  G Western  Grove 

* Jackson,  G.  I. Harrison 

Johnson,  J.  J Harrison 

McCoy,  Orville  B Harrison 

Moore,  W.  T Everton 

Owens,  D.  L Harrison 

Poynor,  W.  H.___ Harrison 

Sims,  G.  K Harrison 

Thompson  J.  I Yellville 

Watkins,  W.  L Alpena  Pass 

Weast,  L.  M Yellville 

BRADLEY  COUNTYt 

Crow,  M.  T ..Warren 

Ellison,  L.  E Warren 

Fike,  W.  T Warren 

Gannaway,  C.  E Warren 

Martin,  C.  N Warren 

Martin,  Rufus Warren 

Reasons,  W.  B Hermitage 

Snodgrass,  W.  A Warren 


* Deceased. 

t Membership  equals  or  exceeds 
that  of  1933. 


CARROLL  COUNTYt 

Bohannan,  J.  H . Berryville 

Butt,  Wm.  Alvin  ._ Green  Fbrest 

Carter,  A.  L.  Berryville 

Huntington,  R.  H.  . Eureka  Springs 

John,  J.  F.  Eureka  Springs 

McCurry,  D.  K. ...Green  Forest 

Pace,  Henry  Eureka.  Springs 

Parker,  J.  R.  Eureka  Springs 

Slusser,  Carl  W Green  Forest 

Stebbins,  N.  1.  Eureka  Springs 

Webb,  J.  H Eureka  Springs 

CHICOT  COUNTYt 

Baker,  E Dermott 

Barlow,  E.  E Dermott 

Burge,  J.  H.  ... ...  Lake  Village 

Clark,  B.  C Lake  Village 

Craig,  Wm.  A.  Eudora 

Douglas,  S.  W.  . Eudora 

Easterling,  W.  D.  Lake  Village 

Easterling,  W.  W. Chicot 

Hutson,  W.  J.  Eudora 

McGehee,  E.  P.  Lake  Village 

Pauli,  A.  J.  ...  Louisville,  Ky. 

Thompson,  J.  A.  Dermott 

CLARK  COUNTYt 

Bremer,  J.  P Point  Cedar 

Bryant,  R.  L.  Arkadelphia 

Carter,  E.  E.  Arkadelphia 

Doane,  S.  N.  Arkadelphia 

Hughes,  F.  A Okolona 

Kirby,  D.  W.  Gurdon 

Reid,  Joe  W Arkadelphia 

Ross,  H.  A Arkadelphia 

Ross,  T.  T Arkadelphia 

Rowland,  W.  T.  Arkadelphia 

Steed,  C.  J.  Gurdon 

Tolleson,  G.  W.  Amity 

Townsend,  C.  K. Arkadelphia 

CLAY  COUNTYt 

Blackwood,  W.  J.  ....  Rector 

Clopton,  O.  H.  Rector 

Cohn,  George  . Piggott 

Cunning,  I.  H.  Knoble 

Custer,  B.  H.  ....  Marmaduke 

Futrell,  J.  B.  Rector 

Hiller,  J.  P.  Pollard 

Jones,  F.  H.  . Piggott 

Latimer,  N.  J.  . Corning 

McGuire,  J.  E.  . Piggott 

Poole,  W.  I.  . St.  Francis 

Richardson,  M.  C Corning 

CLEBURNE  COUNTYt 
Birdsong,  T.  C.  ......  Shiloh 

Hall,  H.  J.  Higden 

Matthews,  J.  T.  Heber  Springs 

CLEVELAND  COUNTYt 

Adams,  T.  L.  ..  ..  . Rison 

Capel,  H.  T. Rison 

Hamilton,  A.  J.  Rison 

Hancock,  W.  G.  ....  ....  . Rison 

COLUMBIA  COUNTYt 
Baker,  J.  J.  . Magnolia 

Carrington,  H.  K.  _.  ...  Magnolia 

Cooksey,  W.  P.  ..... . . Magnolia 

Horn,  W.  H.  ...  ..  Taylor 

Hudnall,  E.  T.  ...  Taylor 

Jones,  T.  H..  Magnolia 

Jordan,  T.  S.  ....  Magnolia 

Kitchens,  H.  M. Waldo 

McLeod,  G.  F.  Magnolia 

McWilliams,  C.  T.  Magnolia 

Rushton,  Joe  F.  . . ..  Magnolia. 

Smith,  P.  M.  . ...  Magnolia 

Souter,  A.  J.  . Waldo 

Walker,  J.  C. Emerson 

CONWAY  COUNTY 
Etheridge,  C.  E..  ...  Morrilton 

Hardison,  T.  W.  Morrilton 

Matthews,  E.  L.  . ...  . Morrilton 

Matthews.  J.  M.  Morrilton 

Mobley,  H.  E.  ....  Morrilton 

CRAIGHEAD-POINSETT 

COUNTY 

Alcott,  G.  B Weiner 

Altman,  J.  T.  ...  ....  Jonesboro 

Baird,  J.  L.  ...  Marked  Tree 

Barrett,  E.  R.  Jonesboro 

Barrett,  R.  M Black  Oak 


Bates,  C.  A. Lake  City 

Berry,  W.  E.  Trumann 

Burge,  H.  G Nettleton 

Cohen,  O.  T.  Jonesboro 

Elders,  J.  W.  ..  Harrisburg 

Ellis,  Ira Monette 

Haltom,  W.  C.  ....  Jonesboro 

Horner,  E.  J.  ._  ...  Jonesboro' 

Jackson,  W.  W.  Jonesboro 

Jernigan,  R.  M.  . ._ Jonesboro 

Jones,  J.  H.  ...  ..  . ...  Lepanto 

Jones,  J.  K.  ....  ...  ....  LepantO' 

Lutterloh,  P.  W Jonesboro 

McAdams,  H.  H.  . . ..  Jonesboro 

McCracken,  C.  P.  ......  Jonesboro 

McCurry,  J.  H.  . ..  Cash 

McDaniel,  L.  H.  Tyronza 

Nesbitt,  Frank  . Brookland 

Overstreet,  W.  C.  . . Jonesboro 

Ramsey,  J.  W.  ..  ...  Jonesboro 

Ratliff,  R.  W.  . . Jonesboro 

Reagan,  C.  H.  Marked  Tree 

Shamlever,  R.  C.  . . ...  Jonesboro 
Sloan,  R.  M.  ....  . Jonesboro 

Stroud,  H.  A.  ...  Jonesboro 

Verser,  W.  W.  Harrisburg 

Willett,  R.  H.  Jonesboro 

CRAWFORD  COUNTYt 

Bennett,  B.  L.  Van  Buren 

Blakemore,  J.  E.  ..  ....  Van  Buren 

♦Bourland,  O.  M Van  Buren 

Bruce,  B.  B.  ....  ........  Alma 

Dibrell,  M.  S.  Van  Buren 

Engler,  F.  G Mountainburg 

Galloway,  Q.  R.  ..  Alma 

Grant,  S.  C.  ....  ...  Mulberry 

Kirkland,  S.  D.  . Van  Buren 

Kirksey,  O.  J.  . ...  Mulberry 
Savery,  H.  W.  ...  Van  Buren 

Stewart,  J.  M . Van  Buren 

Trice,  J.  B.  ..........  Van  Buren 

Wigley,  John  A.  ...  Mulberry 

CRITTENDEN  COUNTYt 

Hare,  T.  S.  ...  Crawfordsville 

Henry,  H.  B.  .....  Fayetteville 

McVay,  L.  C.  ..  . Marion 

Parker,  A.  C...  Clarkedale 

Purnell,  R.  L.  ....  ...  . _ Marion 

Ray,  R.  H.  _.  ...  __  Earl 

Stevenson,  B.  M..  . Crawfordsville 

CROSS  COUNTYt 
Barr,  Austin  Flint  Cherry  Valley 
Griffin,  Walter  L.  ...Cherry  Valley 

Griffin,  J.  Lee  ..  _ Vanndale 

Longest,  Ruffin Wynne 

Miller,  J.  S.  ...  Parkin 

McKie,  J.  D.  Wynne 

*Mc'Kie,  W.  H. Wynne 

Smith,  Richard  S.  . ...  Parkin 

Stewart,  Thomas  J.  Wynne 

Wilson,  Thomas  . ...  . Wynne 

DALLAS  COUNTYt 

Cheatham,  H.  A Princeton 

Flllis,  W.  S. ...  Fordyce 

Estes,  E.  E...  Fordyce 

Lisenbee,  A.  M.  __  Sparkman 

Stuart,  A.  M.  ...  ..  Manning,  Ark. 
Taylor,  J.  E.  M.  ..  Sparkman 

Ward,  W.  P ...  ..Fordyce 

DESHA  COUNTYt 

Biscoe,  Gibbs  Dumas 

Chennault,  J.  C.  ...  McGehee 

Kimbro,  C.  H.  Tillar 

MacCammon,  Vernon  ..  Ark.  City 

Rands,  H.  A.  . ...  ....  . Dumas 

Rosenbaum,  C.  A.  McGehee 

Smith,  H.  T.  _.  McGehee 

Watts,  J.  D.  .....  .....  . Dumas 

White,  R.  F.,  ....  McGehee 

DREW  COUNTYt 
Collins,  A.  S.  J.  Monticello 

Dickins,  R.  D.  ...  Monticello 

DeBolt,  G.  C.  Monticello 

Gates,  S.  M.  . ..  Monticello 

Pope,  M.  Y.  .......  Monticello 

Smith,  R.  N.  . . Collins 

Wilson,  J.  S.  .....  Monticello 

FAULKNER  COUNTYt 

Brittain,  W.  L.  .....  . . _ Conway 

Brooke,  H.  C Conway 


98 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  6 


Cook,  Raymond  C.  Memphis,  Tenn. 

Cureton,  H.  E Conway 

Dawson,  R.  L Wooster 

Dickerson,  C.  H Conway 

Downs,  J.  H Vilonia 

Dunaway,  L.  S.  Jr., Conway 

Fraser,  N.  E Conway 

Glover,  A.  J. Guy 

Hardy,  H.  B Greenbrier 

Harrod,  Geo Conway 

Henderson,  G.  L Conway 

Russell,  Lyle  L Warren 

Kitley,  J.  R Mayflower 

Lieblong,  J.  S Greenbrier 

Mabry,  Tom Holland 

McCollum,  I.  N.  Conway 

McDonald,  W.  T Vilonia 

Muse,  J.  M Conway 

Smith,  Marcus  T Conway 

Westerfield,  J.  S Conway 

Williams,  E.  T Greenbrier 

FRANKLIN  COUNTYt 

Akin,  W.  F.  Branch 

Blackburn,  E.  W Ozark 

Bollinger,  W.  H Charleston 

Douglass,  Thos Ozark 

Gibbons,  W.  H Ozark 

Porter,  W.  C Ozark 

Post,  J.  L . Altus 

GARLAND  COUNTYt 

Biggs,  Orvis  E Hot  Springs 

Black,  T.  N Hot  Springs 

Blackshare,  W.  M... Hot  Springs 

Bollmeier,  L.  N Hot  Springs 

Boydstone,  J.  O Hot  Springs 

Brewer,  Howell . Hot  Springs 

Browning,  E.  R Hot  Springs 

Burns,  Coleman  C Hat  Springs 

Casada,  B.  F Hot  Springs 

Chamberlain,  W.  W Hot  Springs 

Chesnutt,  James  H Hot  Springs 

Clardy,  Floyd Hot  Springs 

Codings,  H.  P Hot  Springs 

Connell,  W.  H Hot  Springs 

Diederich,  V.  P._~ Hot  Springs 

Eckel,  G.  M Hot  Springs 

Ellis,  L.  R Hot  Springs 

Fletcher,  Geo.  B.  Hot  Springs 

Garratt,  Chas.  E Hot  Springs 

Hebert,  Gaston  A Hot  Springs 

Jarrell,  Foster Hot  Springs 

King,  Leon  E Hot  Springs 

King,  O.  H Hot  Springs 

Klugh,  W.  G Hot  Springs 

Lautman,  M.  F Hot  Springs 

Laws,  Wm.  V Hot  Springs 

Lee,  D.  C Hot  Springs 

Lutterloh,  Chas.  H. Hot  Sjrings 

Martin,  Louie  G. Hot  Springs 

MacLaughiin,  O.  J Hot  Springs 

Merrit,  J.  F Hot  Springs 

Moss,  Chas.  S -...Hot  Springs 

Nims,  C.  H Hot  Springs 

Pate,  C.  N Hot  Springs 

Porter,  W.  F Hot  Spring's 

Power,  Allyn  . Hot  Springs 

Preston,  H.  H Hot  Springs 

Proctor,  J.  M Hot  Springs 

Rowland,  J.  F _Hot  Springs 

Sanders,  T.  E Hot  Springs 

Scully,  F.  J Hot  Springs 

Shaw,  Ernest  I Little  Rock,  Ark. 

Shaw,  J.  B Hot  Springs 

Short,  Z.  N — Hot  Springs 

Smith,  Euclid  M Hot  Springs 

Smith,  W.  K Hot  Springs 

Snider,  W.  L Hot  Springs 

Steele,  S.  B Hot  Springs 

Stell,  J.  S.  Hot  Springs 

Stough,  D.  B. Hot  Springs 

Strachan,  J.  B Hot  Springs 

Sullivan,  A.  G. Hot  Springs 

Tribble,  A.  H. Hot  Springs 

Wade,  H.  K Hot  Springs 

Waldrop,  J.  G Hot  Springs 

Weil,  S.  D Hot  Springs 

Wenger,  O.  C ^Hot  Springs 

Wootton,  W.  T Hot  Springs 

Wright,  H.  K Hot  Springs 

GRANT  COUNTYt 

Cole,  C.  F Prattsville 

Hope,  O.  W Sheridan 

Kelly,  O.  R Sheridan 

Paxton,  R,  L Sheridan 


* Deceased. 

t Membership  equals  or  exceeds 
that  of  1933. 


GREENE  COUNTYt 

Blackwood,  J.  D Jonesboro 

Bridges,  G.  P Paragould 

Cupp,  R.  W Beech  Grove 

Dillman,  Jas.  A Paragould 

Ellington,  W.  E Paragould 

Haley,  R.  J.  Sr Paragould 

Hardesty,  C.  A Paragould 

Hudgins,  J.  J. Paragould 

Lamb,  J.  H.  Paragould 

Majors,  W.  M. Paragould 

Scott,  F.  M Paragould 

Self,  G.  S.  - Paragould 

Self,  S.  M.  Walcott,  Ark. 

HEMPSTEAD  COUNTY 

Allison,  W.  G Hope 

Autrey,  ,T.  R.  Columbus 

Cannon,  G.  E.  Hope 

Carrigan.  P.  B Hope 

Gentry,  J.  E.  ..  McCaskill 

Kolb,  A.  C.  Hope 

Lile,  L.  M.  Hope 

Martindale,  G.  H Hope 

Martindale,  J.  G - ..  Hope 

McDonald,  T.  L.  . Hope 

Robins,  Rowland  R. Blevins 

Robins,  W.  F.  Ozan 

Smith,  Don  Hope 

Weaver,  J.  H -..Hope 

HOT  SPRING  COUNTYt 

Barrier,  W.  F. Malvern 

Bramlitt.  E T.  Malvern 

Brown,  H.  L.  Malvern 

Hodges,  W.  G Malvern 

McCray,  E.  H Malvern 

Norton,  J.  M.  Donaldson 

Williams,  J.  M Malvern 

HOWARD-PIKE  COUNTYt 

Alford,  T.  F.  Murfreesboro 

Dildy,  E.  V.  . Nashville 

Duncan,  M D. Murfreesboro 

Gibson,  W.  M. Nashville 

Holcombe,  J.  T.  .Mineral  Springs 

Hopkins,  J.  S.  Nashville 

*Hutchinson.  D.  A Nashville 

Roberts,  J.  L.  Nashville 

Simpson,  W.  B Nashville 

Toiand,  W.  H. Nashville 

Wood,  R.  L Delight 


INDEPENDENCE  COUNTYt 


Brown,  H.  H.  

Churchill,  C.  A. 

Copp,  Noel  . 

Craig,  M.  S ... 

Walnut  Grove 

Batesville 

Calico  Rock 

Evans,  L.  T.  ... 

Gray,  C.  C.  

Gray.  F.  A.  

Harris,  Chas.  T,. 

Batesville 

Batesville 

Batesville 

Melbourne 

Hinkle,  C.  G.  

Hooper,  .T.  M.  

Huskey,  I.  M.  

Jeffery.  Paul  H. 
Johnston,  O.  .T.  T. 

Kennerlv.  J.  H. 

Laman,  G.  T.  

Batesville 

Batesville 

Cave  City 

. Bethesda 

Batesville 

Batesville 

Cave  Citv 

Cord 

Pascoe,  V.  L.  

Robertson,  S.  N.  

_ - Newark 

Sulnhur  Rock 

Smith,  R.  L. 

Melbourne 

Weathers.  .T.  L.  ... 

Woods,  O.  S.  

..  Salem 

JACKSON  COUNTY 

Best,  A.  L.  Newport 

Causey,  G.  A.  Swifton 

Elton,  A.  M.  . Newport 

Erwin,  Ira  H.  . . ...  Newport 

Gray,  C.  R.  Newport 

Harris,  M.  L.  Newport 

Ivy,  J.  B.  .Tuckerman 

Jamison,  O.  A.  Tuckerman 

Kimberlin,  K.  K.  . ...Tuckerman 

Owens,  M.  B.  Newport 

Pierce,  W.  N Tupelo 

Stephens,  G.  K Newport 

Walker,  H.  O Newport 

JEFFERSON  COUNTYt 

Beard,  ,T.  C. Pine  Bluff 

Blackwell,  O.  G Pine  Bluff 

Blankenship.  W.  H Pine  Bluff 

Bruce,  W.  H Pine  Bluff 

Capel.  C.  B.  Pine  Bluff 

Caruthers,  C.  K.  _ Pine  Bluff 

Chavis,  W.  M Pine  Bluff 

Clark,  O.  W Pine  Bluff 

Cunningham,  T.  J Pine  Bluff 


Dunaway,  W.  C Little  Rock 

Gill,  J.  F Pine  Bluff 

Gurney,  J.  O ^ Pine  Bluff 

Hankison,  O.  C . Pine  Bluff 

Higinbotham,  C.  J Pine  Bluff 

Hughes,  A.  A Pine  Bluff 

Jenkins,  J.  S Pine  Bluff 

John,  J.  W.  Pine  Bluff 

Lemons,  J.  M Pine  Bluff 

Lowe,  W.  T Pine  Bluff 

Luck,  B.  D.  Sr Pine  Bluff 

Luck,  B.  D.  Jr Pine  Bluff 

McMullen,  E.  C Pine  Bluff 

Palmer,  J.  T Pine  Bluff 

Payne,  Virgil  Pine  Bluff 

Pittman,  W.  G Pine  Bluff 

Scales,  J.  W. Pine  Bluff 

Shelton,  M.  A. Wabbaseka 

Simmons,  W.  H Pine  Bluff 

Spillyards,  J.  S Pine  Bluff 

Troupe,  A.  W. Pine  Bluff 

Woods,  R.  P Altheimer 

JOHNSON  COUNTYt 

Barger,  M.  I. . Lamar 

Boen, , A.  L.  Clarksville 

Graves,  S.  M Mt.  Levi 

Hardgrave,  Geo.  L Clarksville 

Hunt,  Earle  H Clarksville 

Hunt,  W.  R. Clarksville 

Kolb,  Jas.  M Clarksville 

Kolb,  J.  S Clarksville 

Love,  John  G Hartman 

Mooney,  J.  D Coal  Hill 

Siegel,  G.  R Clarksville 

LAFAYETTE  COUNTY 

Baker,  F.  E. Stamps 

Keith,  A.  W.  Stamps 

McKnight,  J.  F.... Bradley 

Youmans,  F.  W Lewisville 

LAWRENCE  COUNTYt 

Ball,  C.  C Ravenden 

Cruse,  E.  J.  Black  Rock 

Guthrie,  T.  C Smithville 

Gibson,  E.  L Alicia 

Hardeway,  J.  E ..  Lynn 

Hatcher,  W.  W Tmboden 

Henderson,  A.  G Imboden 

Hughes,  J.  C Hoxie 

Hukill,  O.  K Walnut  Ridge 

Hull,  H.  B.  Mammoth  Spring 

Johnston,  Wm Hardy 

Kendall,  W.  S Strawberry 

Land,  J.  C Walnut  Ridge 

McCarroll,  H.  R Walnut  Ridge 

Neece,  T.  C Walnut  Ridge 

Poindexter,  J.  C Imboden 

Rainwater,  Elmer Walnut  Ridge 

Robinson,  W.  J Portia 

Tibbels,  Chas.  D Black  Rock 

Watkins,  G.  Max Walnut  Ridge 

LEE  COUNTYt 

Bean,  W.  B Marianna 

Beaty,  W.  S . Rondo 

Bogart,  H.  D Marianna 

Chaffin,  C.  W Moro 

Crawford,  W.  S Marianna 

Hodge,  N.  C Marianna 

Lewis,  J.  F . Oak  Forest 

Russwurm,  S.  C Hughes 

White,  H.  L Rondo 

Williamson,  O.  L Marianna 

Wilsford,  A.  L Moro 

LINCOLN  COUNTYt 

Dixon,  Chas.  W Gould 

Johnson,  R.  L Grady 

Ringgold,  Geo.  W. . Gould 

Russell,  Manley  Holland  Star  City 

*Tarver,  Benjamin  F. Star  City 

Tarver,  Vernon . ...  Star  City 

Thiolliere,  A.  C ..  ..Gould 

Williams,  A.  F. Comerville 

Wood,  G.  C ..Grady 

LITTLE  RIVER  COUNTYt 

Castile,  Herman  Foreman 

Harding,  C.  A Ashdown 

Heller,  Henry  G Foreman 

Phillips,  P.  H. . Ashdown 

Ringgold,  J.  W Ashdown 

York,  W.  W Ashdown 

LONOKE  COUNTYt 

Beaty,  S.  S England 

Benton,  T.  E Lonoke 

Brewer,  J.  F.  Kerrs 

Callahan,  E.  A.  Carlisle 

Com,  F.  A.  Jr.  Lonoke 

Crowgey,  W.  B Scott 


November,  1934]  ARKANSAS  MEDICAL  SOCIETY 


99 


Ellis,  C.  S Lonoke 

Harris,  E.  H Coy 

Lewis,  John  W KeO' 

Smith,  W.  Meyers Lonoke 

Utley,  F.  E Cabot 

Ward,  O.  D.  England 

Watson,  Asa  C England 

Wells,  J.  B Scott 

MADISON  COUNTYt 

Beeby,  Chas Huntsville 

Counts,  Geo.  D Wesley 

Dixon,  C.  B. - Kingston 

Hill,  N.  J.  Hindsville 

Scott,  James  Berry St.  Paul 

Walker,  G.  D Delhaney 

Youngblood,  Fred Huntsville 

MILLER  COUNTYt 

Beck,  E.  L.  Texarkana 

*Collom,  S.  A Texarkana 

Dale,  Robert Texarkana 

Daniel,  N.  B Texarkana 

Fuller,  T.  E Texarkana 

Hibbitts,  Wm Texarkana 

Hunt,  Preston Texarkana 

Kelley,  K.  M __Texarkana 

Kirkpatrick,  R.  R Texarkana 

Ki'ttrell,  T.  F Texarkana 

Kosminsky,  L.  J Texarkana 

Lanier,  L.  H Texarkana 

Lee,  A.  G Texarkana 

Lennard,  F.  M Texarkana 

Longino,  H.  E Texarkana 

Mann,  Albert  H Texarkana 

Middleton,  B.  C Texarkana 

Murry,  H.  E Texarkana 

Robins,  R.  R—_ Texarkana 

Smiley,  H.  H. Texarkana 

Smith,  W.  D Texarkana 

Webster,  H.  R Texarkana 

Williams,  J.  F Texarkana 

MISSISSIPPI  COUNTYt 

Barksdale,  Oscar Wilson 

Boyd,  D.  L. Blytheville 

Campbell,  J.  H Joiner 

Ellis,  N.  B Wilson 

Harwell,  C.  M Osceola 

Hosey,  N.  R Joiner 

‘Howton,  Oleander Luxora 

Hudson,  Thos.  F Luxora 

Husband,  F.  L Blytheville 

Johnson,  I.  R Blytheville 

Johnson,  R.  L Bassett 

Luckett,  J.  A Dell 

Massey,  L.  D Osceola 

Owen,  W.  M . Armorel 

Polk,  J.  T Keiser 

Robinson,  Finley  A Blytheville 

Sali'ba,  J.  A Blytheville 

Sheddan,  W.  J Osceola 

Sims,  H.  C Blytheville 

Smith,  F.  D. Blytheville 

Stevens,  C.  C Blytheville 

Tidwell,  J.  L Dell 

Tipton,  Paul  L Blytheville 

Washburn,  A.  M Blytheville 

Wilson,  C.  E. Blytheville 

MONROE  COUNTYt 

Boswell,  W.  L Clarendon 

Bradley,  W.  T Blackton 

Dalton,  M.  L . Brinkley 

Dozier,  F.  S Fork  Crook,  Neb. 

*Gilbrech,  A.  H Clarendon 

Henry,  C.  A. . Clarendon 

Martin,  W.  H Holly  Grove 

McKnight,  C.  H : Brinkley 

McKnight,  E.  D Brinkley 

Murphey,  N.  E Clarendon 

Nederhiser,  M.  I . Brinkley 

Terry,  P-  E. Holly  Grove 

MONTGOMERY  COUNTY 

McLean,  J.  H Caddo  Gap 

Robbins,  J.  D Mount  Ida 

NEVADA  COUNTYt 

Buchanan,  A.  S Prescott 

Chastain,  J.  S Prescott 

Dickey,  A.  B. Prescott 

Hesterly,  J.  B Prescott 

Hesterly,  S.  J Prescott 

Hirst,  O.  G.  , Prescott 

Mendenhall,  Thos.  J Rosston 

Shell,  E.  E.  Prescott 


* Deceased. 

t Membership  equals  or  exceeds 
that  of  1933. 


OUACHITA  COUNTYt 

Byrd,  E.  .T.  Bearden 

Clemens,  J.  P.  - Mt.  Holly 

Early,  C.  S.  Camden 

Hathcock,  E.  L.  ..  Locust  Bayou 

Hollingsworth,  G.  F Hampton 

James,  D.  E.  Camden 

Jameson,  J.  B.  Camden 

ICennerly,  R.  C Camden 

McGill,  S.  D Camden 

Partee,  N.  G.  - Stephens 

Plunkett,  C.  M J.  Elliott 

Powell,  B.  V.  Camden 

Purifoy,  W.  A. Chidester 

Rhine,  T.  E.  Thornton 

Rinehart,  J.  S.  Camden 

Ritchie,  C.  E,  Stephens 

Robins,  R.  B,  Camden 

Rushing,  J.  L Chidester 

Sanders,  G.  P.  ..  Stephens 

Smythe,  C.  H Bearden 

Thompson,  H.  F.  Bearden 

Thompson.  Sam  A Camden 

Word,  N.  S.  Camden 

PHILLIPS  COUNTYt 

Baker,  J.  P.  — West  Helena 

Bruce,  W.  B.  — . Marvell 

Butts,  J.  W.  ..  Tucson,  Ariz. 

Cox,  Allen  E.  Helena 

Cox,  Aris  W..  Helena 

Ellis,  J.  B.  Helena 

Fink,  M.  - Helena 

Henry.  Morriss . Helena 

King,  J.  A Elaine 

King.  W.  C Helena 

Nicholls.  J.  W.  Helena 

Orr,  W.  R.  Helena 

Rightor,  H,  II.  Helena 

Russwurm.  W.  C.  .....  Helena 

Storm,  George  R.  ...  West  Helena 

POLK  COUNTYt 

Campbell,  C.  A Hatfield 

Hawkins,  B.  H.  . Mena 

Hilton.  J G.  ..  Mena 

Lee,  F.  A.  Vandervoort 

McElroy,  F.  Q.  Mena 

Mullins,  F.  C.  . Wickes 

Murnhev,  J.  H.  Opal 

Watkins,  P.  R Mena 

POPE  COUNTYt 

Cale,  Walter  Atkins 

Cowan,  Riley  , — . London 

Gardner.  L.  Russellville 

Hood,  Robert  Russellville 

Jones,  R.  A.  Perry 

Scarlett,  W.  P. Russellville 

Smith,  L.  M.  . Russellville 

Smith,  R.  L.  Russellville 

Tate,  A.  B.  Russellville 

PRAIRIE'  COUNTYt 

Adams,  Edward DeValls  Bluff 

Crockett,  W.  H Biscoe 

Gilliam,  J.  C. Des  Arc 

Lynn,  J.  R.  . ~ Hazen 

Parker,  Luke  . DeValls  Bluff 

Parker,  Wm.  McK. DeValls  Bluff 

Porter,  T.  G Hazen 

Williams,  W.  F.  B. Des  Arc 

Wilson,  J.  G.  ...  ..... _ Ulm 

PULASKI  COUNTYt 

Allen,  Estes.  . . ...  Little  Rock 

Allen,  H.  R.  Little  Rock 

Arkebauer,  Chas.  A.  ....  Little  Rock 
Atkinson.  Shelby  ....  N.  Little  Rock 

Autrv,  Paul  G. Combs,  Ark. 

Bailey,  W.  E.  Little  Rock 

Barrier,  L.  F ....  Little  Rock 

Bennett,  B.  A Little  Rock 

Blakely,  R.  M ..Little  Rock 

Bond,  S.  P.  ....  Little  Rock 

Brooks,  C.  M Little  Rock 

Brown,  L.  R. Little  Rock 

Brown,  Thomas  D Tattle  Rock 

Calcote,  R.  J Little  Rock 

Caldwell,  Robert Little  Rock 

Carruth,  O.  A Little  Rock 

Carruthers,  F.  W Little  Rock 

Cazort,  Alan  G Little  Rock 

Cheairs,  D.  T, Tattle  Rock 

Chesnutt,  C.  R Little  Rock 

Choate,  H,  L. Little  Rock 

Compton,  John  N Little  Rock 

Coon,  A.  B. Little  Rock 

Cosgrove,  K.  W. Little  Rock 

Crawford,  J.  B ...  Little  Rock 

Crawford,  S.  R Little  Rock 

Crow,  Ed  W Little  Rock 

Cummins,  Bryce Little  Rock 


Cunningham,  J.  C. Little  Rock 

Darnall,  R.  F Little  Rock 

Davis,  J.  C Little  Rock 

Day,  E.  O Little  Rock 

Delaney,  J.  P Fayetteville 

DeWolf,  H.  F Little  Rock 

Dibrell,  J.  L Little  Rock 

Dibrell,  J.  R. ..._.. Little  Rock 

Dishongh,  H.  A. Little  Rock 

Eubanks,  R.  M Little  Rock 

Fly,  T.  M.  Little  Rock 

Freemyer,  W.  N Little  Rock 

Fulmer,  P.  M Little  Rock 

Fulmer,  S.  C Little  Rock 

Gann,  Dewell  Jr Little  Rock 

Garrison,  C.  W Lexington,  Ky. 

Gray,  A.  F Little  Rock 

Gray,  Oscar  Little  Rock 

Gray,  Wm.  Ed  Jr Little  Rock 

Grayson,  W.  B Little  Rock 

Hardeman,  Daniel  R Little  Rock 

Harris,  R.  P Sykesville,  Md. 

Hastings,  Gordon Little  Rock 

Hayes,  John  Harry Mansfield,  O. 

Hayes,  John  Me Little  Rock 

Heliums,  Julius  H Little  Rock 

Higgins,  H.  A Little  Rock 

Hinkle,  S.  B Little  Rock 

Hoge,  S.  F Little  Rock 

Holmes,  Glenn  M Little  Rock 

Howell,  A.  R N.  Little  Rock 

Howze,  H.  H Hines,  111. 

Hundling,  H.  W Little  Rock 

Hurrle,  F.  E Little  Rock 

Hyatt,  D.  T Little  Rock 

Jackson,  Geo.  F Little  Rock 

Jewell,  I.  H Paris 

Jobe,  A.  L. Little  Rock 

Johnson,  Glenn  H Little  Rock 

Jones,  H.  F.  H Little  Rock 

Jones,  .las.  E Little  Rock 

Junki'n,  S.  P. Little  Rock 

Kilbury,  M.  J Little  Rock 

Kinley,  James  D Beebe 

Kirby,  A.  C ....Little  Rock 

Kory,  R.  C Little  Rock 

Kriesel,  W.  A Little  Rock 

Langston,  Wm.  C Little  Rock 

Lamb,  W.  A Little  Rock 

Law,  Ralph  A. Little  Rock 

Levy,  Jerome  S Little  Rock 

Lewis,  Geo.  V Little  Rock 

Linzy,  J.  R :. N.  Little  Rock 

Mahoney,  P.  L Little  Rock 

Matthews,  W.  M Little  Rock 

May,  C.  B ....Little  Rock 

May,  John  R Little  Rock 

McCaskill,  M.  E Little  Rock 

McCormack,  G.  A. Little  Rock 

McRae,  W.  M Little  Rock 

Melson,  Madeline  M. Little  Rock 

Melson,  O.  C Little  Rock 

Miller,  W.  H Little  Rock 

Mountford,  A.  H. N.  Little  Rock 

Murphey,  Pat Little  Rock 

Oates,  Chas.  E N.  Little  Rock 

Parmley,  L.  V Little  Rock 

Parsons,  John  E.  Jr Little  Rock 

Parsons,  W.  R Washington,  D.C. 

Patterson,  R.  Q Little  Rock 

Pirnique,  A.  F : Little  Rock 

Ponder,  E.  T. Little  Rock 

Pryor,  R.  E.  Little  Rock 

Reagan,  G.  W Little  Rock 

Reagan,  L.  D Little  Rock 

Reed,  C.  C Little  Rock 

Regnier,  W.  A Little  Rock 

Rhinehart,  B.  A Little  Rock 

Rhinehart,  D.  A Little  Rock 

Richardson,  W.  R. Little  Rock 

Riegler,  N.  W.  Little  Rock 

Robinson,  Byron  L. Little  Rock 

"'Robinson,  F.  C Little  Rock 

Rodgers,  Clyde  D Little  Rock 

Roe,  Joe  L.  Little  Rock 

Rogers,  F.  O. Little  Rock 

Russell,  Allen  R. Little  Rock 

Sadler,  W.  L Little  Rock 

Sanderlin,  .T.  H Little  Rock 

Sanford,  Sloan  M Little  Rock 

Saxon,  R.  L Little  Rock 

Scott,  Homer  Little  Rock 

Shearer,  W.  <F. Little  Rock 

Sheppard,  J.  P Little  Rock 

Shipp,  A.  C Little  Rock 

Shuffield,  J.  F Little  Rock 

Smith,  John  Me Russellville 

Smith,  Morgan  Little  Rock 

Smith,  Randolph  T Little  Rock 

Smith,  W.  F. Little  Rock 

Snodgrass,  W.  A. Little  Rock 

Spitzberg,  Irving  J Little  Rock 


100 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  6 


Stover,  A.  R.  Oak  Park,  111. 

Strauss,  A.  W Little  Rock 

Summers,  J.  A N.  Little  Rock 

Switzer,  D.  M N.  Little  Rock 

Thatcher,  Harvey  S Little  Rock 

Thomas,  P.  E Little  Rock 

Thompson,  G.  D Little  Rock 

Thompson,  E.  I Little  Rock 

Vinsonhaler,  Frank Little  Rock 

Wallace,  R.  A Little  Rock 

Wallis,  Chas Little  Rock 

Wassell,  C.  McA Little  Rock 

Watkins,  Anderson Little  Rock 

Watkins,  John  G Little  Rock 

Wayman,  A.  K Little  Rock 

Wayne,  J.  R Little  Rock 

Wayne,  W.  D.  Little  Rock 

Webb,  V.  T Little  Rock 

Weny,  N.  F Little  Rock 

White,  E.  H Little  Rock 

Wilson,  P.  W Little  Rock 

Witt,  C.  E Little  Rock 

RANDOLPH  COUNTYt 

Baltz,  M.  A Pocahontas 

Brown,  J.  W Pocahontas 

Finney,  Clarence Maynard 

Hamil,  W.  E Pocahontas 

Handley,  E.  L Pocahontas 

‘Hughes,  W.  E Pocahontas 

Loft  is,  J.  R. Pocahontas 

Ryburn,  J.  W Pocahontas 

Smith,  J.  E Reyno 

Smith,  Robt.  Oscar Biggers 

SAINT  FRANCIS  COUNTYt 

Bogart,  C.  N Forrest  City 

Bogart,  J.  A Forrest  City 

Boggan,  P.  P Forrest  City 

Burch,  N.  B. Hughes 

Burch,  W.  D Hughes 

Caldwell,  A.  B Forrest  City 

Chaffin,  E.  J. Hughes 

Davidson,  J.  S Forrest  City 

McCown,  N.  C Forrest  City 

Rush,  J.  O Forrest  City 

Winter,  W.  A Widener 

SALINE  COUNTY 

Blakely,  M.  M Benton 

Buckley,  E.  A Bauxite 

Burks,  J.  A Benton 

Gann,  Dewell  Sr Benton 

Jones,  C.  W Benton 

Walton,  Chas Leavenworth,  Kan. 

Ward,  W.  W Alexander 

Watson,  Thos.  C Benton 

SCOTT  COUNTYt 

Bevill,  Cheves Waldron 

Burnett,  J.  A Waldron 

Duncan,  B.  W Waldron 

Duncan,  F.  R Waldron 

Duncan,  L.  D. Waldron 

Holitik,  Geo.  F.  Waldron 

Jones,  Paul Mound  Valley,  Kan. 

Sorrell,  L.  B Waldron 

SEARCY  COUNTYt 

Cotton,  J.  O. Leslie 

Daniel,  Sam  G Marshall 

Fendley,  E.  G Leslie 

Henley,  J.  A— Marshall 

Leslie,  J.  O Marshall 

Pate,  J.  C Leslie 

Rogers,  W.  F. St.  Joe 

Wood,  E.  W Marshall 

SEBASTIAN  COUNTYt 

Amis,  J.  W . Fort  Smith 

Benefield,  C.  E Fort  Smith 

Benefield,  J.  H. Fort  Smith 

Billingsley,  C.  B Fort  Smith 

Blair,  A.  A Fort  Smith 


* Deceased. 

t Membership  equals  or  exceeds 
that  of  1933. 


Brooksher,  W.  R. Fort  Smith 

Buckley,  J.  H Fort  Smith 

Bungart,  C.  S Fort  Smith 

Coffman,  J.  S Lavaca 

Dorente,  D.  R Fort  Smith 

Dorsey,  H.  C Fort  Smith 

Eberle,  W.  G Fort  Smith 

Epler,  E.  G. _..  lone,  Ark. 

Foltz,  J.  A Fort  Smith 

Foster,  M.  E Fort  Smith 

Freer,  B.  W. Fort  Smith 

Goldstein,  D.  W Fort  Smith 

Hall,  C.  W Greenwood 

Henry,  L.  M Fort  Smith 

Hoge,  A.  F Fort  Smith 

Holt,  C.  S Fort  Smith 

Honomichl,  O.  R ...  Hackett 

Jeffery,  T.  E Fort  Smith 

Jeffery,  V.  J Fort  Smith 

Johnson,  Hugh Fort  Smith 

Johnson,  J.  E ..Fort  Smith 

Jones,  E.  B . Hartford 

Jones,  I.  F. Fort  Smith 

Kennedy,  C.  H Fort  Smith 

Krock,  F.  H. Fort  Smith 

McConnell,  S.  P Booneville 

Means,  C.  S Fort  Smith 

Moulton,  E.  C Fort  Smith 

Moulton,  H Fort  Smith 

Nowlin,  R.  R State  Sanatorium 

Ogden,  J.  C. Fort  Smith 

Redman,  Pierre Fort  Smith 

Riley,  J.  D. State  Sanatorium 

Rose,  W.  F Fort  Smith 

Scott,  M.  H. Jenny  Lind 

Smith,  H.  H.  Fort  Smith 

Southard,  J.  D Fort  Smith 

Southard,  J.  S. Fort  Smith 

Stevenson,  E.  H Fort  Smith 

Stevenson,  J.  E Fort  Smith 

Stubbs,  S.  P Fort  Smith 

Taylor,  J.  M Fort  Smith 

Ware,  B.  L. Greenwood 

Willingham,  J.  J._.State  Sanatorium 

Wolfermann,  S.  J Fort  Smith 

Woods,  G.  G Huntington 

Wyatt,  R.  B Sulphur  Springs 

Yankoff,  P.  D Fort  Smith 

SEVIER  COUNTYt 

Archer,  C.  A DeQueen 

Clingan,  A.  J DeQueen 

Dickinson,  R.  C Horatio 

Graves,  J.  C Lockesburg 

Hendrix,  Ben  E Gillham 

Jones,  I.  G DeQueen 

Kitchens,  C.  E DeQueen 

Norwood,  M.  L Lockesburg 

Phillips,  C.  M Levelland,  Tex. 

Yates,  E.  W Mena 


UNION  COUNTYt 


Cathey,  A.  D 

Cullins,  J.  G 

-N.  Chicago,  111. 

Elkins,  W.  N 

Junction  City 

‘Ferguson,  J.  V 

Fincher,  L.  G 

El  Dorado 

El  Dorado 

Hardin,  M.  A 

Irbv,  F.  L.  ... 

Kennedy,  C.  E 

LeVine,  David 

Mahony,  F.  O 

Mayfield,  H.  F.  .... 
McCall,  Daniel 

Smackover 

El  Dorado 

El  Dorado 

Huttig 

McGraw,  S.  J . 

Mitchell,  J.  G 

Moore,  B.  L. 

Moore,  J.  A.  

Munn,  E.  J 

Murphy,  G.  D.  

El  Dorado 

El  Dorado 

El  Dorado 

El  Dorado 

Murphy,  H.  A 

Newton,  W.  L 

Purifoy,  L.  A 

Purifov,  L.  L. 

El  Dorado 

El  Dorado 

El  Dorado 

Ritterman,  Henry. 

Russell,  M.  V. 

Sheppard,  J.  K 

Norphlet 

El  Dorado 

Cascade,  la. 

Sheppard,  J.  M El  Dorado 

Slaughter,  J.  H Norphlet 

Slaughter,  J.  W El  Dorado 

Smith,  D.  V.  Huttig 

Smith,  J.  M. Smackover 

Vines,  F.  P.  El  Dorado 

Vines,  C.  L.  Kilgore,  Tex. 

Wharton,  J.  B El  Dorado 

White,  D.  E El  Dorado 

Wozencraft,  W.  L El  Dorado 

WASHINGTON  COUNTYt 

Baggett,  Jeff Prairie  Grove 

Bean,  J.  L.  Morrow 

Briley,  J.  H Springdale 

Callen,  Clyde  B Fayetteville 

Cooper,  T.  L Elm  Springs 

Ellis,  E.  F Fayetteville 

Ellis,  Ruth  Fayetteville 

Fowler,  W.  A Fayetteville 

Gilbert,  A.  A Fayetteville 

Gray,  T.  E ...Winslow 

Gregg,  A.  S.^ Fayetteville 

Harr,  H.  T Fayetteville 

Hathcock,  Alfred Fayetteville 

Hathcock,  Preston  L.  - Fayetteville 

Hathcock,  P.  L.  Sr Fayetteville 

Haugen,  I.  J Prairie  Grove 

Henry,  R.  T. Springdale 

Houston,  Hugh West  Fork 

McCormick,  E.  G Prairie  Grove 

Mock,  W.  H. Prairie  Grove 

Morrow,  F.  R Fayetteville 

Richardson,  Fount Fayetteville 

Riggall,  Cecil Prairie  Grove 

Roberts,  D.  C... Fayetteville 

Robinson,  James  A Summers 

Sisco,  C.  P. Springdale 

Walker,  J.  W Fayetteville 

Wallace,  J.  M Fayetteville 

Wood,  H.  D.. Fayetteville 

WHITE  COUNTYt 

Abington,  E.  H Beebe 

Allbright,  S.  J Searcy 

Brewer,  T.  E Beebe 

Clark,  W.  A Bald  Knob 

Dunklin,  A.  J. Searcy 

Felts,  W.  R Judsonia 

Hardy,  F.  P Center  Hill 

‘Harrison,  A.  G Searcy 

Havner,  J.  B Beebe 

Hawkins,  M.  C.  Jr Searcy 

Hudgins,  A.  H Searcy 

Little,  R.  L.  Judsonia 

Parker,  O.  Searcy 

Peeler,  C.  M... Pangburn 

Sloan,  D.  W Beebe 

Sloan,  J.  R. Garner 

Spain,  A.  L.  Letona 

Tapscott,  S.  T Searcy 

Walls,  J.  M.  ..Searcy 

Woodyard,  W.  H.  L. Judsonia 

WOODRUFF  COUNTYt 

Biles,  Lee  E Augusta 

Brewer,  Edward  F Augusta 

Brewster,  B MeCrory 

Brown,  E.  B. Cotton  Plant 

Dungan,  Calvin  E Augusta 

Evans,  R.  H.  MeCrory 

Fraser,  R.  L.  MeCrory 

Hays,  J.  F.  Augusta 

Maguire,  F.  C. ...  Augusta 

Mathis,  W.  J oCtton  Plant 

Morris,  J.  W MeCrory 

Murphy,  Frank oCtton  Plant 

West,  J.  H. Grays 

Wilkins,  W.  T oCtton  Plant 

YELL  COUNTYt 

Ballenger,  Wm.  E Plainview 

Grace,  Jesse  Kent Mt.  Nebo 

Haster,  E.  .T.  ..Dardanelle 

Millard,  Roy  I.  Dardanelle 

Montgomery,  H.  L Gravelly 

Pool,  Thomas  J. Ola 


The  membership  roster  of  the  Arkansas  Medical  Society  for  1934  has  been 
placed  in  the  center  of  this  issue  of  The  Journal  in  order  that 
it  may  be  readily  removed  for  filing. 


November,  1934]  ARKANSAS  MEDICAL  SOCIETY 


101 


THE  HAWKINS  BLADDER,  VAGINAL 
AND  RECTAL  GUIDE 
Martin  C.  Hawkins,  Jr.,  M.  D.,  F.A.C.S. 

Searcy 

This  instrument  is  designed  for  the  pur- 
pose of  facilitating  speed  and  safety  in 
surgery  of,  and  around  the  bladder,  vagina 
and  rectum,  and  as  a diagnostic  aid.  It  is 
particularly  useful  when  placed  in  the 
bladder  during  an  anterior  colporrhaphy, 
vaginal  hysterectomy,  or  abdominal  hys- 
terectomy, to  definitely  locate  the  limits 
of  the  bladder  wall,  especially  in  separat- 
ing the  bladder  wall  from  adjoining  tis- 
sues. Used  in  this  manner  it  will  prevent 
the  accidental  opening  of  the  bladder  or 
traumatization  of  its  walls.  It  may  also 
be  used  as  a guide  and  support  in  surgery 
of,  and  around  the  urethra,  and  in  fistulae 
of  the  urethra,  bladder,  vagina  and  rec- 
tum. The  larger  24  mm.  rectal  bulb  is 
designed  to  supplant  the  finger  placed  in 
the  rectum  when  doing  plastic  work  on 
the  vagina  or  rectum,  particularly  in  the 


(3^ ' = 

Bladder  and  Urethral  Bulb 
8m.m.  Diam. — 16  c.m.  Long 


Long  Section  °24  m.m  Diam. °4c.m.  Long 

Description — Figure  1 

A.  Bulb — Soft,  semi-elastic,  non-collapsible 
hollow  rubber  bulb,  sizes  6,  8,  10  and  12  mm.  in 
diameter  by  IV2  to  2 cm.,  corresponding  to  the 
different  diameters.  Rectal  bulb  24  mm.  by  4 
cm. 

A1.  Metal  attachment — IV2  cm.  long.  Part 
that  fits  into  grooved  end  of  bulb  is  concentrical- 
ly ridged  or  knobbed  to  fit  groove  in  open  small 
end  of  the  bulb.  The  portion  of  the  wall  of  the 
bulb  to  which  this  metal  piece  is  attached  is 
thickened  as  illustrated.  Projecting  screw  end 
of  metal  attachment  is  3 mm.  in  diameter  so  as 
to  fit  screw  socket  (b1)  of  handle,  thus  making 
the  circumference  of  the  bulb  uniform  with  the 
attachment  end  of  the  handle. 

B.  Handle — A rod  27  cm.  long,  3 mm.  in  diam- 
eter, of  soft  non-corrosive  metal  (malleable),  with 
screw  socket  (b1)  5 mm.  in  diameter  for  recep- 
tion of  bulb  screw.  Proximal  end  of  the  handle 
is  3%  by  3%  cm.  in  ring  shape  (b2). 


repair  of  an  episiotomy  wound  as  well  as 
in  old  lacerations  of  the  perineum  and  rec- 
to-vaginal structures,  since  it  can  be  pal- 
pated through  the  vagina  and  avoids  sut- 
uring into  the  rectum.  In  diagnosis,  it 
may  be  used  as  a mechanical  finger  to  de- 
termine the  thickness,  consistency  and 
presence  of  palpable  lesions  and  the  ten- 
derness of  the  bladder  and  rectum  by  pal- 
pating through  the  vagina  against  the  rub- 
ber bulb. 

Advantages — The  soft  rubber  bulbs  are 
relatively  nontraumatic  as  compared  with 
the  metal  sounds  now  generally  used  as 
guides.  The  rubber  bulb  acts  as  a base, 
guide  and  mobilizer  in  repairing  fistulae, 
simulating  the  end  of  the  finger  if  such 
could  be  placed  in  the  bladder.  The  mal- 
leability of  the  handle  insures  any  position 
or  shape  desired.  The  ring  end  of  the 
handle  can  be  used  as  a retractor  of  small 
parts,  as  of  the  bladder  in  vaginal  hys- 
terectomy. All  bulbs  fit  the  same  handle. 
<s> 

Resolution 


WHEREAS,  Dr.  Walton  W.  Lowe  was  called 
by  death  at  his  home  in  Gillette,  Arkansas,  on 
the  16th  day  of  September,  1934,  after  a few 
hours  illnes,  and 

WHEREAS,  In  the  death  of  Dr.  Lowe,  Arkan- 
sas County  lost  one  of  its  most  distinguished  and 
respected  citizens,  and 

WHEREAS,  In  the  death  of  Dr.  Lowe,  the  Ark- 
ansas County  Medical  Society  lost  one  of  its  most 
useful  and  loyal  members,  and 

WHEREAS,  This  Society  realizing  to  the  full- 
est extent  the  loss  which  it  has  sustained  in  the 
sad  passing  of  this  brother  and  fully  realizing  the 
still  greater  loss  sustained  by  those  nearest  and 
dearest  to  him, 

THEREFORE,  BE  IT  RESOLVED,  That  we 
extend  to  the  family  of  our  deceased  member  our 
tender  condolences  in  this  their  hour  of  sorrow 
and  commend  them  to  the  keeping  of  the  Heavenly 
Father  who  looks  with  compassion  upon  those 
who  mourn,  and 

BE  IT  FURTHER  RESOLVED,  That  this  res- 
olution be  spread  upon  the  minutes  of  this  meet- 
ing as  a tribute  to  the  memory  of  one  who  was 
held  in  the  highest  esteem  and  respect  by  his 
fellow  physicians. 

Arkansas  County  Medical  Society, 

M.  C.  John,  President. 

J.  E.  Neighbors,  Secretary. 

C.  E.  Park, 

Homer  Whitehead, 

Resolutions  Commtitee. 


102 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  6 


Proceedings  of  Societies 


The  Southeast  Arkansas  Medical  Socie- 
ty met  at  Monticello  September  17th  for 
the  following  program : 

“Practical  Points  in  Gynecology” — Per- 
cy Wood,  Memphis. 

“Toxemia  of  Pregnancy” — Percy  Rus- 
sell, Memphis. 

“Epidemiology  of  Malaria” — A.  M. 
Gibbs,  Hamburg. 

The  Tenth  Councilor  District  Medical 
Society  met  at  Fort  Smith  on  September 
18th  with  operative  clinics  conducted  at 
Sparks  Memorial  and  St.  Edward’s  Mercy 
Hospitals  by  Drs.  J.  H.  Buckley,  M.  E. 
Foster,  A.  F.  Hoge,  C.  S.  Holt,  F.  H.  Krock 
and  J.  A.  Foltz.  The  following  dry  clinics 
were  presented : “Glioma  of  Retina,”  E.  C. 
Moulton;  “Heart  Disease,”  A.  A.  Blair; 
“Malaria,”  M.  S.  Dibrell;  and  “Demon- 
stration of  the  Warwick  Ionode  Machine,” 
R.  T.  Smith.  The  following  papers  were 
presented  at  the  afternoon  session:  “Ob- 
stetrics in  the  Country,”  Thos.  Douglas, 
Ozark;  “Differential  Diagnosis  of  Pulmo- 
nary Tuberculosis,”  C.  R.  Williams,  State 
Sanatorium;  “Advisability  of  Routine 
Physical  Examination,  Particularly  of 
Women  Between  Thirty-five  and  Fifty 
Years  Old,”  Ruth  Ellis,  Fayetteville;  and 
“Pain  in  Heart  Disease,”  A.  B.  Chase,  Ok- 
lahoma City.  Newly-elected  officers  are: 

I.  F.  Jones,  Fort  Smith,  President;  J.  D. 
Riley,  State  Sanatorium,  Vice-president; 
and  Fount  Richardson,  Fayetteville,  Secre- 
tary. The  1935  meeting  will  be  held  in 
Fayetteville. 

Woodruff  County  Medical  Society  has 
elected  the  following  officers:  President, 

J.  H.  Hays,  Augusta;  Vice-president,  W. 
T.  Wilkins,  Cotton  Plant;  and  Secretary- 
Treasurer,  L.  E.  Biles,  Augusta. 

The  Pulaski  County  Medical  Society  was 
addressed  October  1st  by  Dr.  John  L.  Kan- 
tor,  New  York,  on  “Functional  Disturb- 
ances of  the  Gastro-Intestinal  Tract,”  and 
by  Paul  B.  Magnuson,  Chicago,  on  “Diag- 
nosis of  the  Causes  of  Low  Back  Pain.” 

The  society  was  addressed  at  a special 
meeting  October  6th  by  A.  C.  Ivy,  Chicago, 
on  “Etiology  and  Therapeutic  Rationale  of 
Peptic  Ulcer.” 


The  Mississippi  County  Medical  Society 
met  at  Blytheville  October  2nd,  for  a pro- 
gram by  Memphis  physicians:  “Skin  Dis- 
eases,” R.  G.  Henderson,  and  “Allergy,” 
J.  P.  Henry. 

F.  D.  Smith,  Secy. 


At  the  October  9th  meeting  of  the  Se- 
bastian County  Medical  Society  the  follow- 
ing program  was  presented : “Some  Phas- 
es of  Acute  Pelvic  Inflammatory  Disease,” 
J.  S.  Southard,  and  “The  Toxemias  of 
Pregnancy,”  J.  W.  Amis. 


Over  75  physicians  attended  the  fourth 
clinical  conference  of  the  staffs  of  the  Leo 
N.  Levi  Memorial  Hospital  and  Charles 
Steinberg  Clinic  at  Hot  Springs  National 
Park,  October  11th.  In  addition  to  the 
guest  speakers,  Col.  W.  B.  Meister,  Chief 
of  Medical  Service,  Army  and  Navy  Gen- 
eral Hospital,  and  Geo.  R.  Livermore,  Pro- 
fessor of  Urology,  University  of  Tennes- 
see, the  following  staff  members  partici- 
pated in  the  program:  Drs.  W.  M.  Black- 
share,  J.  0.  Boydstone,  Howell  Brewer,  W. 
W.  Chamberlain,  V.  F.  Diederich,  G.  B. 
Fletcher,  L.  E.  King,  0.  H.  King,  W.  G. 
Klugh,  M.  F.  Lautman,  D.  C.  Lee,  C.  H. 
Lutterloh,  H.  0.  Lynch,  L.  G.  Martin,  0. 
J.  MacLaughlin,  A.  R.  Power,  H.  H.  Pres- 
ton, E.  M.  Smith,  D.  B.  Stough,  A.  G.  Sul- 
livan, F.  S.  Tarleton,  A.  H.  Tribble,  H.  K. 
Wade  and  S.  D.  Weil. 


The  Second  Councilor  District  Medical 
Society  met  in  dinner  session  at  Batesville 
October  8th.  Speakers  were:  F.  0.  Ma- 
hony,  El  Dorado,  “The  Medical  Practi- 
tioner in  This  Changing  World”;  E.  C. 
Mitchell,  Memphis,  “The  Upper  Respira- 
tory Tract  Infections  of  Children”;  Joe  F. 
Shuffield,  Little  Rock,  “Principles  in  the 
Treatment  of  Some  Common  Fractures” ; 
and  H.  H.  McAdams,  Jonesboro,  “Fibroid 
Tumors  of  the  Uterus”  (motion  picture 
presentation).  The  following  officers  were 
elected:  President,  J.  T.  Matthews,  Heber 
Springs;  Vice-president,  Paul  Jeffery, 
Bethesda;  and  Secretary-Treasurer,  0.  J. 
T.  Johnston,  Batesville.  The  society  will 
meet  at  Batesville  during  April,  1935. 

0.  J.  T.  Johnston,  Secy. 

Pope  County  Medical  Society  met  in 
dinner  session  at  Russellville  October  11th 


November,  1934]  ARKANSAS  MEDICAL  SOCIETY 


103 


for  the  following  program  :“Gall  Bladder 
Disease  and  Associated  Pathology,”  John 
M.  Smith  and  “Dietetic  Treatment  of  Gall 
Bladder  Disease,”  Robert  Hood. 


The  Fifth  Councilor  District  Medical 
Society  met  at  Camden  October  11th  with 
more  than  60  physicians  in  attendance  to 
hear  Dr.  Hugh  Leslie  Moore,  Dallas,  Pres- 
ident, Southern  Medical  Association;  Dr. 
Geo.  Carlisle,  Associate  Professor  of  Clini- 
cal Medicine,  Baylor  University,  Dallas; 
and  Dr.  J.  A.  Warner,  Professor  of  Bac- 
teriology, Saint  Louis  University. 

<8> 

Personal  and  News  Items 


Speakers  at  the  Tri-State  Medical  So- 
ciety, Shreveport,  October  16th  and  17th, 
were:  L.  J.  Kosminsky,  responding  to  ad- 
dress of  welcome,  and  B.  A.  Rhinehart,  on 
“Modern  Gastroenterology.” 

Ira  Ellis  has  been  elected  a director  of 
the  Monette  Chamber  of  Commerce. 


C.  W.  Garrison  has  accepted  an  appoint- 
ment as  City  Health  Officer  of  Lexington, 
Kentucky. 


T.  T.  Ross,  Arkadelphia,  who  was 
awarded  a Rockefeller  scholarship  in  Pub- 
lic Health  at  Harvard  University,  began 
his  studies  October  1st.  Dr.  Myron  Smith, 
formerly  with  the  Lonoke  County  Health 
Unit,  will  relieve  Dr.  Ross  with  the  Clark 
County  Unit. 


C.  M.  Harwell,  Osceola,  addressed  the 
Frisco  System  Medical  Association  at 
Saint  Louis,  October  8th  on  “The  General 
Practitioner  in  Obstetrics.” 


R.  J.  Calcote,  Little  Rock,  was  granted 
the  certificate  of  the  American  Board  for 
Opthalmic  Examinations  on  September 
8th. 


“The  Practitioner  of  Medicine  in  This 
Changing  World,”  by  President  Mahony 
appears  in  the  September  Tri-State  Med- 
ical Journal. 


H.  A.  Stroud  addressed  the  Jonesboro 
Nurses’  Association  October  2nd  on  “Co- 
operation of  Physicians  With  the  Nurses’ 
Registry.” 


B.  D.  Luck,  Sr.,  Pine  Bluff,  took  post- 
graduate work  at  the  Mayo  Clinic  in  Sep- 
tember. 


Visitors  to  the  Century  of  Progress  dur- 
ing September  were  Dr.  and  Mrs.  H.  T. 
Smith,  McGehee,  and  Dr.  and  Mrs.  W.  G. 
Hodges,  Malvern.  Dr.  Smith  also  attend- 
ed the  Conference  of  State  Secretaries  held 
on  September  21st. 


The  National  Research  Council  has 
awarded  Paul  L.  Day,  Little  Rock,  a grant 
of  $250  for  work  on  vitamin  G. 


Joe  W.  Reid  has  opened  an  office  for 
practice  at  Arkadelphia. 


W.  B.  Grayson  addressed  the  Crawford 
County  Council  of  Women  at  Alma,  Octo- 
ber 6th,  on  “Health.” 


The  Arkansas  State  Nurses’  Associa- 
tion was  addressed  at  its  meeting  in  Tex- 
arkana, October  30-31st,  by  Drs.  W.  B. 
Grayson,  L.  J.  Kosminsky,  R.  R.  Kirkpat- 
rick, and  J.  K.  Smith. 


E.  M.  Gray,  Evening  Shade,  has  moved 
to  Mountain  Home  where  he  will  be  as- 
sociated in  practice  with  J.  T.  Tipton. 

S.  A.  Drennen  was  elected  acting  mayor 
of  Stuttgart  October  3rd. 

Drs.  Geo.  F.  Jackson  and  F.  W.  Car- 
ruthers,  Little  Rock,  addressed  the  Lincoln 
County  Medical  Society  September  7th. 

“Preventing  Arthritis,”  by  M.  F.  Laut- 
man,  Hot  Springs  National  Park,  appears 
in  the  November  issue  of  Hygeia. 

The  Holt-Krock  Clinic,  Fort  Smith,  has 
moved  offices  to  their  own  building,  the 
former  Saint  John’s  Hospital. 

The  following  attended  the  Fall  Clinical 
Conference  of  the  Kansas  City  Southwest 
Clinical  Society:  C.  S.  Bungart,  Fort 

Smith;  J.  H.  Fowler,  Harrison;  L.  Gard- 
ner, Russellville;  J.  G.  Gladden,  Western 
Grove;  E.  J.  Haster,  Dardanelle;  Robert 
Hood,  Russellville ; H.  Fay  H.  Jones,  Little 
Rock ; F.  H.  Krock,  Fort  Smith ; D.  L. 
Owens,  Harrison;  U P.  Cisco,  Springdale, 
and  R.  L.  Smith,  Russellville. 


104 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  6 


Auxiliary  Page 


Mrs.  D.  W.  Goldstein,  Publicity  Secretary. 
616  North  Greenwood  Ave.,  Fort  Smith. 


The  annual  fall  executive  board  session  of  the 
Woman’s  Auxiliary  to  the  Arkansas  Medical  So- 
ciety was  held  September  27th  at  the  Albert  Pike 
hotel,  with  20  state  officers,  committee  chair- 
men and  presidents  of  county  auxiliaries  in  at- 
tendance. 

The  business  session,  followed  by  luncheon,  was 
presided  over  by  Mrs.  Wm.  Hibbits,  president. 
Mrs.  L.  J.  Kosminsky  of  Texarkana,  successor  to 
the  late  Mrs.  R.  R.  Kirkpatrick  of  Texarkana,  as 
treasurer,  was  introduced.  The  resignation  of 
Mrs.  P.  M.  Smith,  Magnolia,  fourth  vice-presi- 
dent was  accepted  and  Mrs.  J.  B.  Jameson,  Cam- 
den, elected.  The  resignation  of  Mrs.  D.  W. 
Goldstein,  Fort  Smith,  parliamentarian,  was  ac- 
cepted and  Mrs.  F.  M.  Williams,  Hot  Springs, 
elected. 

Business  included  discussion  of  programs  to 
be  carried  out  this  winter  by  county  auxiliaries 
under  auspices  of  the  state  auxiliary.  Stress  was 
laid  upon  education,  public  health,  public  rela- 
tions and  physical  health  examination. 

State  officers  attending  were:  Mesdames  H.  E. 
Murry,  Texarkana;  D.  W.  Goldstein,  Fort  Smith; 
B.  A.  Rhinehart  and  Chas.  E.  Oates,  Little  Rock; 
P.  H.  Phillips,  Ashdown;  C.  G.  Hinkle,  Bates- 
ville;  Marcus  T.  Smith,  Conway;  Chas.  E.  Gar- 
ratt,  Hot  Springs;  Anderson  Watkins,  Little 
Rock;  P.  M.  Smith,  Magnolia;  and  Mrs.  C.  W. 
Garrison,  Little  Rock.  State  chairmen  of  com- 
mittees present  were:  Mesdames  Garratt;  J.  T. 
McLain,  Gurdon;  C.  E.  Oates;  B.  A.  Bennett,  Lit- 
tle Rock;  S.  A.  Collom,  Texarkana;  Pierre  Red- 
man, Fort  Smith;  S.  R.  Hinkle;  Curtis  Jones, 
Benton;  C.  A.  Archer,  DeQueen ; L.  H.  Lanier, 
Texarkana;  E.  A.  Callahan,  Carlisle;  and  T.  G. 
Porter  of  Hazen.  County  presidents  attending 
were:  Mesdames  J.  E.  Stevenson,  Fort  Smith;  C. 
E.  Kitchens,  DeQueen;  L.  S.  Dunnaway,  Jr.,  Con- 
way; L.  T.  Evans  of  Batesville,  and  A.  L.  Carter 
of  Berryville. 


Miller  and  Bowie  County  Auxiliary  meeting  on 
September  7th  preceded  a beautifully  appointed 
luncheon  given  by  the  president,  Mrs.  Decker 
Smith  in  the  Grim  Hotel  honoring  the  officers 
of  the  Texas  and  Arkansas  Medical  Auxiliaries, 
Mrs.  Preston  Hunt,  Texas  president;  Mrs.  Wil- 
liam Hibbitts,  Arkansas  president;  Mrs.  L.  J. 
Kosminsky,  Arkansas  treasurer;  Mrs.  J.  T.  Rob- 
inson, Texas  corresponding  secretary,  and  Mrs. 
H.  E.  Murry,  Arkansas  recording  secretary.  Plans 
were  completed  for  the  entertainment  of  the 
Texas  executive  board  on  October  20th. 

On  September  9th  we  held  our  public  relations 
meeting  for  the  year.  Dr.  S.  E.  Thompson  of 
Kerrville,  Texas,  president  of  the  Texas  State 
Medical  Association,  sponsored  by  our  Auxiliary, 


addressed  a large  audience  on  “Health  Problems 
Are  Individual  Responsibilities.” 

Mrs.  Joe  Tyson,  Chairman 
Publicity  Committee. 


Mrs.  B.  V.  Powell  and  Mrs.  Sam  Thompson 
were  hostesses  to  the  Auxiliary  of  the  Ouachita 
County  Medical  Society  on  Thursday  evening  at 
the  Powell  home.  Quantities  of  roses  of  varied 
hues  were  used  as  decorations  throughout  the 
house  and  a delicious  three-course  dinner  was 
served  by  the  hostesses.  Covers  were  laid  for 
ten  members.  The  following  new  officers  were 
installed:  Mrs.  B.  V.  Powell,  president;  Mrs.  J. 
S.  Rinehart,  president-elect;  Mrs.  R.  C.  Kenner- 
ly,  vice  president,  and  Mrs.  J.  B.  Jameson,  sec- 
retary-treasurer. 


The  Woman’s  Auxiliary  to  the  Arkansas  Med- 
ical Society  extends  greetings  and  a happy  wel- 
come to  our  new  auxiliary,  the  Lawrence  County 
Auxiliary  with  Mrs.  P.  C.  Neece,  President. 


We  wish  to  express  our  sincere  sympathy  to 
Dr.  W.  H.  Poynor  and  family  of  Harrison,  and 
to  the  Boone  County  Medical  Auxiliary  in  the 
loss  of  Mrs.  Poynor,  who  passed  away  during 
the  summer. 


AN  INVITATION 

The  Woman’s  Auxiliary  to  the  Southern  Medi- 
cal Association  will  meet  in  San  Antonio,  Texas, 
November  13th  to  16th. 

Headquarters  for  the  women  will  be  in  the  St. 
Anthony  Hotel,  where  all  meetings,  luncheons  and 
dinners  will  be  held. 

It  is  earnestly  desired  that  our  women  of  the 
South  will  make  every  effort  to  attend  this  meet- 
ing “en  masse.”  Your  presence  will  not  only 
help  the  meeting  but  will  be  a great  inspiration 
to  you  yourselves.  San  Antonio  is  delightful  and 
everything  possible  is  being  done  to  make  your 
visit  enjoyable. 

A cordial  and  pressing  invitation  is  extended 
to  everyone  to  attend  the  Auxiliary  Luncheon  on 
Wednesday,  Nov.  14th,  to  meet  Mrs.  Robert  Tom- 
linson, National  Auxiliary  President,  and  other 
distinguished  guests. 

Most  cordially  yours, 

Mrs.  Southgate  Leigh,  President. 

The  outgoing  and  incoming  Presidents,  Mes- 
dames 0.  J.  T.  Johnston  and  L.  T.  Evans,  of  the 
Auxiliary  to  the  Independence  County  Medical 
Society,  and  their  husbands,  were  the  honor  guests 
at  a lovely  dinner  given  recently  by  Dr.  and  Mrs. 
G.  T.  Laman  of  Cave  City.  The  members  of  both 
the  Independence  County  Medical  Society  and  the 
Auxiliary  were  invited  to  this  dinner  at  the  Bar- 
nett Hotel.  Twenty-one  guests  were  present. 
After  the  dinner  they  attended  the  picture  show, 
where  seats  had  been  reserved  for  them. 


November,  1934]  ARKANSAS  MEDICAL  SOCIETY 


105 


Book  Reviews 


Postures  and  Practices  during  Labor  Among 
Primitive  People,  Adaptions  to  Modern  Obstet- 
rics, with  chapters  on  taboos  and  superstitions 
and  postpartum  gymnastics:  By  Julius  Jarcho, 
M.  D.,  F.  A.  C.  S.  160  Pages  with  130  illustra- 
tions. Published  by  Paul  Hoeber,  Inc.,  New 
York.  Price  $3.50. 

This  work  is  the  result  of  extensive  study  of 
the  postures  and  practices  of  primitive  peoples 
of  yesterday  and  today.  It  covers  the  field  both 
as  to  time  and  territory  and  clearly  shows  that 
all  people  for  all  time  have  given  thought  to  the 
treatment  of  difficult  labors.  While  more  atten- 
tion has  been  given  to  the  postures  and  maneuv- 
ers looking  to  the  assistance  of  the  woman  in 
labor,  a very  complete  study  of  the  taboos, 
charms,  religious  and  crude  medical  practices  of 
the  primitives  is  included.  The  author  shows 
that  many  of  their  practices,  both  postural  and 
medicinal  are,  though  highly  refined,  in  use  to- 
day. Body  glands,  the  placenta,  urine  etc.,  both 
of  humans  and  of  lower  animals,  were  used  by 
the  ancients.  Now  some  of  these  are  the  highest 
priced  items  in  the  modern  drug  store  and  mil- 
lions are  being  spent  on  their  study.  He  gives 
credit  for  their  efforts  and  deals  gently  with 
their  cruelties. 

Being  Jarco  he  could  not  fail  to  give  us  the 
practical  value  of  his  studies.  The  chapter  on 
Anthropology  and  Post-partum  Gymnastics  alone 
is  worth  the  price  of  the  book. 

It  is  well  printed  and  bound  and  extensively 
illustrated. 

— S.  B.  H. 


The  Complete  Pediatrician:  Practical,  Diagnos- 
tic, Therapeutic  and  Preventitive  Pediatrics.-  By 
Wilburt  C.  Davison,  M.  A.,  D.  Sc.,  M.  D.,  Pro- 
fessor of  Pediatrics,  Duke  University  School  of 
Medicine,  Fellow  American  Academy  of  Pedia- 
trics and  American  College  of  Physicians,  Mem- 
ber White  House  Conference,  etc.,  Duke  Univer- 
sity Press,  1934. 

The  compact  volume  contains  essentials  of  pe- 
diatrics, arranged  in  the  order  of  use  in  prac- 
tice; history,  examination,  diagnosis  and  treat- 
ment. The  findings  are  listed  and  under  these 
will  be  found  their  explanation,  a departure  from 
customary  text-book  style.  Cross-references,  well 
done,  add  to  the  usefulness  of  the  book.  It  is 
recommended  to  all  physicians  interested  in  pe- 
diatrics. 


Radiologic  Exploration  of  the  Mucosa  of  the 
Gastro-Intestinal  Tract.  By  the  Cole  Collabora- 
tors: Lewis  Gregory  Cole,  M.  D.,  Robert  E.  Pound, 
M.  D.,  William  Gregory  Cole,  M.  D.,  Russell  R. 
Morse,  M.  D.,  Courtenay  I.  Headland,  M.  D.,  and 
Ames  W.  Maslund,  M.  D.  Price  $7.50.  Pp.  336, 
with  262  illustrations  St.  Paul  and  Minneapolis: 
Bruce  Publishing  Company,  1934. 

This  volume  is  a description  and  analysis  of 
the  fundamental  roentgenologic  principles  upon 


which  the  roentgenological  diagnosis  of  various 
gastro-intestinal  tract  lesions  must  be  based.  The 
authorship  recommends  the  work  to  every  roent- 
genologist, veteran  or  neophyte.  The  senior  author 
routinely  employed,  as  early  as  1910,  the  mucosal 
relief  study  of  the  gastro-intestinal  tract,  now 
the  subject  of  a voluminous  literature.  Always 
an  adherent  of  serial  roentgenograms  as  opposed 
to  roentgenoscopy,  Cole  describes  an  essentially 
roentgenographic  technic  in  this  volume,  the  sat- 
isfactory results  of  which,  as  performed  by  Cole, 
are  conceeded  by  other  roentgenologists,  the  ma- 
jority of  whom  rely  upon  screen  observations. 
The  work  deals  with  (1)  the  lumen  of  the  tract 
viewed  in  profile,  (2)  special  folds  of  the  mu- 
cosa viewed  on  edge,  (3)  pliability  of  the  mucosa 
to  peristaltic  contraction  and  (4)  the  mucosal 
pattern  folds,  all  as  applied  to  the  examination 
of  the  esophagus,  stomach,  duodenum,  small  bowel 
and  colon.  The  monograph  is  well-written  in- 
deed, typographically  attractive,  and  is  to  be  read 
and  studied  with  profit  by  roentgenologists  and 
gastro-enterologists.  It  is  also  recommended  to 
those  physicians  who  wish  a familiarity  with  the 
fundamental  principles  of  roentgenologic  diag- 
nosis of  gastro-intestinal  tract  lesions. 


Colwell’s  Daily  Log  For  Physicians.  By  John 
B.  Colwell,  M.  D.,  Colwell  Publishing  Company, 
Champaign,  Illinois.  Price  $6.00. 

This  is  an  exceedingly  compact,  yet  complete 
financial  record  system,  well  printed  and  durably 
bound.  Provision  is  made  for  a complete  daily 
record  of  all  patients  treated  with  the  financial 
disposal  of  each  case.  The  monthly  summary 
and  expense  sheet  are  of  definite  value  in  ac- 
curate record-keeping  and  provide  in  an  efficient 
manner  the  information  which  most  physicians 
frantically  seek  about  March  12th  from  cancelled 
checks  and  receipted  bills.  Special  records,  as 
obstetrical  cases  and  personal  accounts,  complete 
this  well-arranged  book.  To  the  physician  who 
experiences  difficulty  in  arranging  his  income 
tax  forms  and  who  desires  a more  accurate  sum- 
mary of  the  cycle  of  his  professional  success, 
this  book  is  a welcome  solution. 


The  Sinister  Shepherd:  A Translation  of  Giro- 
lamo Fracastoro’s  Syphilidis  Sive  De  Morbo  Gal- 
lico  Libri  Tres,  by  William  Van  Wyck.  The  Pri- 
mavera  Press,  Los  Angeles.  1934.  $4.50. 

This  poem  was  published  in  1530  by  Girolamo 
Francastoro,  the  Veronese  physician  who  was 
considered  to  be  one  of  the  foremost  scholars  of 
Italy.  Aside  from  its  value  as  a poem,  this  work 
gives  the  reader  a good  idea  of  the  theories  of 
the  origin,  cause,  symptoms  and  treatment  of 
syphilis  in  the  sixteenth  century.  Some  of  his 
theories  are  no  longer  held  in  esteem,  but  the 
reader  will  appreciate  his  proximity  to  the  truth 
in  many  instances. 

The  translation  by  William  Van  Wyck  theo- 
rizes that  syphilis  was  brought  back  to  Europe 
by  Columbus  and  his  sailors,  but  Francastoro 
believed  that  it  had  been  present  in  Europe  for 
several  centuries.  Astrologers  believed  that 


10b 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  6 


syphilis  was  caused  by  the  planets,  while  theol- 
ogians believed  that  God  had  sent  it  to  punish 
the  wicked.  Francastoro  saw  that  the  affection 
was  of  a contagious  nature  and  an  infection  of 
the  blood,  harmful  to  man.  He  observed  that  the 
union  of  sexes  or  the  contact  of  babies  with  wet 
nurses,  could  cause  it. 

The  poem  describes  the  cutaneous  manifesta- 
tions of  the  infection,  especially  the  serous,  pus- 
tular and  scabby  forms.  It  mentions  the  falling 
of  the  hair,  the  syphilitic  lesions  of  the  palate, 
pharynx  and  eyes;  inflammation  of  bones,  local- 
ized nocturnal  pains,  anemia,  general  debility  and 
cachexia. 

In  the  treatment  the  author  of  the  poem  advo- 
cates mercury  above  all  other  forms  of  treatment. 
Red  oxide  of  lead  was  used  to  dry  the  ulcers. 
Storax  was  used  as  a stimulant  and  antimony 
was  used  to  cause  sweating.  Peas,  leeks,  cucum- 
bers, pork  and  liquor,  were  forbidden.  Some 
thought  that  oranges  and  lemons  produced  cures. 

— E.  I.  T. 


That  Heart  of  Yours.  By  S.  Calvin  Smith,  M. 
D.,  Sc.  D.,  212  pages.  Published  by  J.  B.  Lippin- 
cott  Co.,  Philadelphia.  Price  $2.00. 

This  book  might  well  be  the  first  prescription 
given  a patient  suffering  from  any  form  of  car- 
diac trouble.  Though  it  does  not  minimize  the 
seriousness  of  any  cardiac  condition,  it  brings  to 
the  suffering  reader  an  assurance  that  the  re- 
gime laid  down  for  his  guidance  by  his  physician, 
if  followed  conscientiously,  will  not  necessarily  be 
in  vain,  that  there  is  a wide  field  of  usefulness 
and  pleasure  open  to  the  cardiopath,  and  that 
heart  disease  need  not  inevitably  shorten  life.  It 
emphasizes  the  fact  that  symptoms  frequently  re- 
ferred to  the  heart  are  not  always  evidences  of 
heart  disease,  but  may  be  warnings  of  trouble 
elsewhere  and  their  appearance  should  be  imme- 
diately followed  by  a thorough  physical  exami- 
nation. 

A safe,  hopeful,  well-written  book,  authorita- 
tive, and  muchly  needed  at  this  time. 

— L.  F.  B. 


Spinal  Anesthesia.  Technic  and  Clinical  Appli- 
cation. By  George  Rudolph  Vehrs,  M.  D.,  Salem, 
Oregon.  Cloth,  269  pages,  illustrated.  Price  $5.50. 
The  C.  V.  Mosby  Company,  St.  Louis,  1934. 

This  book,  as  the  author  states  in  the  preface, 
“constitutes  a survey  of  the  experimental  and 
clinical  records  in  the  field  of  spinal  anesthesia 
for  the  past  forty-nine  years.” 

The  subject  is  very  thoroughly  and  completely 
covered  in  a concise  and  exceedingly  instructive 
manner.  Beginning  with  the  definition  the 
author  carries  you  through  the  history,  special 
anatomy,  heart  and  respiration,  general  circula- 
tory and  metabolic  factors,  indications,  contrain- 
dications, complications  and  mortality,  special 
care  of  patients,  technique,  operations,  regional 
and  total  anesthesia,  and  finishes  with  a short 
discussion  on  spinal  anesthesia  in  obstetrics.  The 
chapters  on  general  circulatory  and  metabolic 
factors  and  on  the  care  of  patients  under  spinal 


anesthesia,  which  includes  the  selection  of  pa- 
tients for  this  type  of  anesthesia,  preoperative 
and  postoperative  care,  are  especially  interest- 
ing. 

Spinal  anesthesia  unquestionably  has  a large 
place  in  surgery  today,  and,  as  Doctor  Vehrs 
states  in  his  conclusion,  “any  surgeon  who  has 
qualified  himself  in  the  application  of  spinal  and 
regional  anesthesia  has  done  more  for  the  preser- 
vation of  the  patient’s  life  than  can  be  done  by 
any  other  measures.  He  is  using  an  analgesic 
which  preserves  the  normal  metabolic  processes 
while  all  the  nonvital  functions  are  placed  at  rest 
and  the  blood  sugar  and  oxygen  are  mobilized  to 
support  the  heart,  respiration  and  brain-stem 
centers.” 

This  monograph  will  be  of  invaluable  service  to 
every  surgeon  who  reads  it. — M.  E.  F. 


The  Laboratory  Notebook  Method  in  Teaching. 

Physical  Diagnosis  and  Clinical  History  Record- 
ing. By  Logan  Clendening,  M.  D.,  Professor  of 
Clinical  Medicine  in  the  University  of  Kansas. 
Pp.  71,  Price  fifty  cents.  C.  V.  Mosby,  Publish- 
ers, St.  Louis. 

In  this  small  volume  the  author  has  presented 
in  a concise,  but  all  inclusive  manner,  the  im- 
portant points  in  obtaining  a complete  and  exact 
history  as  well  as  presenting  the  most  systematic 
and  logical  manner  of  obtaining  the  salient  points 
in  a routine  physical  examination.  Besides  giv- 
ing information  as  to  the  best  method  of  obtain- 
ing this  material,  the  author  also  presents  meth- 
ods of  recording  this  information  in  a manner  to 
be  of  most  assistance  in  making  the  diagnosis  and 
recording  the  progress  of  the  case. 

This  book  is  an  excellent  work  and  a great  aid 
in  routine  history  taking  and  physical  examina- 
tion. It  should  be  of  especial  interest  to  in- 
ternes and  medical  students. — T.  P.  F. 


THE  USE  OF  RADIUM 


The  following  resolution  was  presented  by  the 
Executive  Committee  and  adopted  unanimously  by 
the  American  Radium  Society,  Cleveland  Session, 
June  12,  1934. 

WHEREAS,  it  has  been  proven  that  radium 
and  x-ray,  when  used  properly  and  in  suffi- 
cient quantity,  is  efficient  in  the  treatment  of 
cancer  in  certain  locations,  and 

WHEREAS,  there  is  a general  fear  in  the 
public  mind  from  x-ray  or  radium  burns,  which 
because  of  this  fear,  prevents  competent  radio- 
logists from  using  sufficient  radium  or  x-ray  to 
produce  the  best  results. 

BE  IT  RESOLVED  that  we  as  radiologists  rec- 
ognize that  in  the  treatment  of  malignant  dis- 
ease, it  is  often  necessary  to  carry  the  treatment 
on  to  the  extent  of  producing  a violent  reaction 
in  the  surrounding  tissues,  which  may  cause  the 
skin  to  peel,  and  blisters  to  form,  in  order  to 
give  sufficient  treatment  to  overcome  the  malig- 
nant disease.  We  believe,  therefore,  that  it  is 
justifiable  to  produce  a second  degree  radiodor- 
matitis  when  necessary. 


November,  1934]  ARKANSAS  MEDICAL  SOCIETY 


107 


MEDICAL  MEN  FOR  THINGS  MEDICAL 


“The  principle  that  medical  men  should  be  the 
ones  to  exercise  control  over  medical  service  is 
almost  axiomatic.  Yet  there  is  confusion  of 
thought  where  there  could  be  straight  thinking 
if  all  the  facts  were  brought  out  and  faced. 

“There  are  those  who  would  virtually  make 
the  physician  an  employee  of  the  state.  They 
fail  to  recognize  the  utter  incompatibility  be- 
tween the  American  political  system  and  the 
methods  of  truly  professional  men. 

“There  are  those  who  complain  about  the 
scarcity  of  physicians.  Yet  it  is  a fact  that 
while  England  has  one  doctor  for  1,490  per- 
sons, France  one  for  1,690,  and  Sweden  one  for 
2,890,  there  is  in  the  United  States  one  physi- 
cian for  every  780  persons. 

“There  are  those  who  denounce  our  hospitals 
on  the  score  of  high  charges  for  service,  but  the 
truth  is  that  the  cost  per  day  of  a hospital  room 
with  meals  and  the  day  and  night  personal  min- 
istrations required  by  an  invalid  is  usually  less 
than  a well  person  would  pay  for  mere  room  and 
meals  in  a first-class  hotel. 

“There  are  those  who  would  like  to  let  down 
the  bars  to  self-medication.  Yet  the  fact  is  that 
during  the  last  few  generations  the  average  span 
of  human  life  has  been  extended  ten  years,  chief- 
ly through  the  discoveries  of  medical  science. 

“Physicians  know  these  things.  They  spend 
years  acquiring  an  education  on  the  care  and 
repair  of  the  most  marvelous  mechanism  on  earth 
— the  human  body.  But  they  would  readily  ad- 
mit that  this  education  does  not  qualify  them  for 
telling  railroad  executives  how  to  solve  trans- 
portation problems  or  impressarios  how  to  stage 


an  opera.  The  work  of  the  world  needs  many 
kinds  of  specialized  knowledge,  but  certain  it  is 
that  each  field  of  work  will  be  best  managed 
by  those  who  know  it  best.” — From  Mead  John- 
son & Company’s  announcement  in  Hygiea,  Aug- 
ust, 1934. 

<g> 

Contrary  to  popular  belief,  it  is  both  the  heat 
and  the  humidity  that  make  one  uncomfortable  in 
hot  weather,  according  to  Dr.  Lee  D.  Cady  whose 
article  “Your  Skin  Is  Your  Refrigerator”  ap- 
pears in  the  August  Hygeia. 

If  the  kidneys  are  healthy,  one  may  increase 
the  amount  of  common  salt  in  the  food  or  even 
drink  a little  in  water.  If  the  day  is  extremely 
hot,  one  may  need  a total  intake  of  salt  amount- 
ing to  about  1 heaping  teaspoonful.  The  added 
salt  replaces  that  lost  from  the  blood  stream  by 
excessive  perspiration;  if  its  normal  constituents 
are  not  supplied,  the  blood  stream  passes  on  its 
starvation  for  salts  to  the  tissue  cells. 

Overdrinking  of  fluids  should  not  be  indulged 
in,  for  that  tends  to  produce  the  very  thing  that 
should  be  avoided ; namely,  a relatively  great  salt 
concentration  in  the  tissue  cells. 

Food  should  be  varied  to  be  more  suitable  for 
hot  weather.  One  does  not  need  much  heat-pro- 
ducing food  such  as  meat  and  other  proteins,  the 
digestion  of  which  throws  off  heat. 

<$> 

ERRATUM. 

CHILDHOOD  TUBERCULOSIS 
A.  A.  Blair,  M.  D.,  F.  A.  C.  P. 

A typographical  error  occurs  in  the  twenty- 
ninth  line,  page  76,  October  issue  of  The  Journal 
in  which  it  is  stated  that  25  per  cent  phenol  is 
used  as  a preservative.  This  should  read  twenty- 
five  hundredths  per  cent. 


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ADDRESS 

THE  RALPH  SANITARIUM  - 529  Highland  Avenue  - KANSAS  CITY,  MO. 

TELEPHONE  VICTOR  4850 


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THE  JOURNAL 

^ of  the  ARKANSAS  MEDICAL  SOCIETY 

PUBLISHED  MONTHLY  UNDER  DIRECTION  OF  THE  COUNCIL  gj§| 

. Voi.  XXXI  FORT  SMITH,  ARKANSAS,  DECEMBER,  1934  No.  7 


UTERINE  HEMORRHAGE* 

1.  FULTON  JONES,  M.  D. 

Fori  Smith 


Menorrhagia  or  metrorrhagia,  or  any  abnorm- 
ality of  the  menstrual  flow  is  not  physiological. 
Most  women  suspect  this,  and  all  doctors  should 
be  certain  of  it.  Unfortunately,  many  women 
still  attach  little  importance  to  this  supposedly 
temporary  disturbance  of  the  menstrual  flow. 
The  fact  that  any  abnormality  of  the  menstrual 
flow  indicates,  without  exception,  a cause  of 
disease,  must  appear  axiomatic  to  any  scientific 
as  well  as  any  informed  person. 

The  determination  of  the  cause  has  been 
and  still  is  impossible  in  countless  cases.  Yet 
that  fact  does  not  excuse  the  medical  profes- 
sion from  using  all  their  facilities  and  knowledge 
in  search  of  the  underlying  pathology.  We 
should  ever  remember  Lawson  Tait's  admonition, 
"any  practitioner  seriously  neglects  his  duty  who 
undertakes  the  treatment  of  a patient  in  which 
menorrhagia  is  a symptom,  without  carefully  in- 
forming her  of  the  utter  uselessness  of  such  treat- 
ment until  there  is  a clear  perception  of  the  con- 
dition present." 

The  equipment  necessary  to  carry  out  these 
fundamental  examinations  is  neither  bulky  nor 
expensive.  The  main  requirements  are  time,  in- 
telligence, plus  the  natural  senses,  with  a good 
light  and  a bivalve  speculum.  Yet,  with  these 
minimum  requirements,  we  find  that  too  many 
doctors  are  too  lazy,  too  busy,  or  too  ignorant 
to  demand  a pelvic  examination  before  treat- 
ment is  fnstituted. 

I have  always  found  that  any  diagnosis  is  made 
easier  if  it  can  be  classified  under  a "rule  of 
thumb."  Cullen  classified  uterine  hemorrhage 
under  two  headings;  one,  those  dependent  on 
recent  pregnancy,  and  two,  those  independent 
of  recent  pregnancy.  Under  each  one  of  these 
classifications  he  lists  a number  of  causes  which 
I will  divide  into  five  groups,  so  that  we  have  a 

* Read  before  the  Fifty-ninth  annual  session  of  the 
Arkansas  Medical  Society,  held  in  Little  Rock,  April  16- 
18,  1934. 


heading  for  each  "finger,"  the  two  main  head- 
ings being  represented  by  the  two  hands. 

The  five  headings  under  the  first  classifica- 
tion, those  conditions  dependent  on  recent  preg- 
nancy, are: 

1.  Placenta  Praevia. 

2.  Premature  Separation  of  the  Placenta. 

3.  Retained  Secundines. 

4.  Hydatid  Mole  and  Chorio-epithelioma. 

5.  Tubal  Pregnancy. 

PLACENTA  PRAEVIA. — Here  we  have  the 
history  of  pregnancy  with  bleeding  appearing 
after  the  fourth  month.  We  find,  without  fail, 
sufficient  bleeding  to  account  for  the  symptoms 
present. 

PREMATURE  SEPARATION  OF  THE  PLA- 
CENTA.— We  have  the  history  of  pregnancy  and 
we  are  most  interested  in  trying  to  prevent  an 
abortion.  If  this  condition  appears  in  the  latter 
months  of  pregnancy  it  is  sometimes  hard  to 
differentiate  from  placenta  praevia.  In  this  case 
we  do  not  find  sufficient  vaginal  bleeding  to 
account  for  the  symptoms. 

RETAINED  SECUNDINES.— H ere  we  have  the 
history  of  pregnancy,  but  we  must  ever  be  on  the 
lookout  for  the  patient  who  wants  a currettement. 
Be  sure  that  she  has  seen  some  pieces  of  "flesh" 
passed. 

HYDATID  MOLE. — We  remember  the  beauti-j 
ful  illustration  in  the  text-book  and  will  always  rec- 
ognize it.  Fortunately  it  is  not  common.  We  find 
a woman  with  the  history  of  pregnancy,  who 
for  some  unaccountable  reason  is  not  going  along 
as  well  as  she  should.  We  do  not  want  to  in- 
terrupt the  pregnancy,  but  something  has  to  be 
done.  When  we  begin  to  dilate  the  womb  we 
notice  these  "grape-like"  clusters,  and  wonder  if 
it  will  be  necessary  to  do  anything  radical  to 
prevent  a chorio-epithelioma.  It  is  well  to  re- 
member that  chorio-epithelioma  develops  in  the 
musculature  of  the  uterus  and  that  you  can  not 
obtain  any  information  from  scrapings.  The  only 
treatment  is  hysterectomy.  As  there  are  a num- 
ber of  cases  of  hydatid  mole  which  do  not  be- 
come malignant,  each  case  should  be  watched, 
studied,  and  followed  by  the  Aschheim-Zondek 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  7 


I 10 


test.  As  long  as  that  test  is  negative,  then  it  is 
considered  safe  to  wait;  but  if  it  is  positive,  then 
a hysterectomy  should  be  performed. 

TUBAL  PREGNANCY. — Thirty  years  or  so  ago 
this  diagnosis  was  rarely  made  before  operation. 
Now  we  not  only  make  practically  all  of  them  in 
which  rupture  has  taken  place,  but  pride  ourselves 
in  making  the  diagnosis  before  rupture.  A patient 
who  has  gone  over  two  weeks  and  begins  to  bleed 
a few  drops  and  has  a peculiar  sensation  in  one 
side  of  the  lower  abdomen  should  be  watched 
very  carefully  for  a tubal  pregnancy;  especially 
so,  if  she  has  had  one  child  and  it  is  several  years 
of  age.  A vaginal  examination  will  usually  give 
you  a mass  or  a peculiar  feeling  on  one  side  of 
the  adnexa.  You  should  treat  that  patient  as  a 
case  of  unruptured  tubal  pregnancy  until  proved 
otherwise.  An  Aschheim-Zondek  test  will  aid 
very  materially.  A pregnancy  in  one  horn  of  a 
bicornate  uterus  is  a tubal  pregnancy  in  rela- 
tion to  the  non-pregnant  side. 

We  now  go  to  the  second  division  or  "hand"; 
those  conditions  that  are  not  related  to  recent 
pregnancy,  namely: 

1.  Hemorrhage  due  to  constitutional  condi- 
tions. 

2.  Hemorrhage  due  to  benign  changes  in  the 
mucosa  of  the  cervix  and  body  of  the  uterus. 

3.  Hemorrhage  due  to  malignant  changes  in 
the  mucosa  of  the  cervix  and  body  of  the  uterus. 

4.  Hemorrhage  due  to  the  presence  of  uter- 
ine tumors. 

5.  Hemorrhage  due  to  disease  of  the  adnexa. 

HEMORRHAGE  DUE  TO  CONSTITUTIONAL 
CONDITONS. — Here  we  find  the  blood  dyscra- 
sias.  According  to  Kahn,  Virchow,  Novak,  Wei- 
bel  and  Kelly  it  seems  doubtful  if  its  importance 
is  sufficiently  recognized.  Uterine  hemorrhage  is 
sometimes  the  primary  and  most  important  symp- 
tom of  an  underlying  blood  dyscrasia.  It  has  been 
found  in  all  blood  dyscrasias  but  thrombocyto- 
poenic  purpura  and  leukemia  seem  the  most  com- 
mon. 

HEMORRHAGE  DUE  TO  BENIGN  CHANG- 
ES IN  THE  MUCOUS  MEMBRANE  OF  CERVIX 
AND  BODY  OF  THE  UTERUS.- — -Under  this  head- 
ing we  find  polypi,  both  cervical  and  endome- 
trial; also  atrophic  mucosa  in  elderly  women. 
Polypi  conform  to  the  histology  of  the  tissue 
from  which  they  arise.  There  are  larger  hemor- 
rhages from  the  endometrial  than  from  the  cer- 
vical type.  They  are  rather  difficult  to  diagnose 
if  not  seen  on  vagina!  examination.  They  can 


cause  profuse  hemorrhages.  We  occasionally 
see  hemorrhage  from  the  mucosa  in  elderly  per- 
sons. 

Hyperplasia  of  the  Endometrium. — This  term 
has  borne  the  brunt  of  many  undiagnosed  cases. 
Whenever  the  etiology  of  the  hemorrhage  was 
obscure  and  the  physician  in  doubt,  he  put  it 
under  this  classification.  Here  we  have  the  pro- 
fuse and  prolonged  menstrual  periods.  Curet- 
tage was  the  treatment  "par  excellence"  until 
the  recent  studies  of  Aschheim-Zondek,  Novak 
and  others.  Now  we  know  that  the  uterus  was 
simply  the  offending  organ  and  the  cause  was 
from  the  hormones  of  the  ovary  and  the  pitui- 
tary. The  present  belief  is  that  this  condition 
is  one  of  the  functional  type,  similar  to  that  seen 
in  young  girls.  The  treatment  of  course  must  be 
different,  for  in  the  young  individuals  we  must 
try  and  preserve  the  ovarian  function;  in  the  el- 
derly it  is  not  of  such  importance.  The  story  is 
a long  one  that  has  been  climaxed  by  the  bril- 
liant work  of  Smith,  Engle,  Ascheim  and  Zon- 
dek in  their  demonstration  of  the  role  played  by 
the  anterior  pituitary  lobe  over  the  function  of 
the  ovary.  The  theory  is  that  the  hyperplasia 
is  due  to  a lack  of  the  luteinization  hormone. 

Immediately  after  menstruation,  the  follicles 
begin  to  mature  and  for  some  reason  one  of 
them  ripens  first  and  becomes  the  governing 
hormone  of  the  period.  This  period  is  controlled 
by  the  hormone  from  the  anterior  pituitary  called, 
Prolan  A.  The  follicle  ruptures  about  the  13th 
day  when  the  corpus  luteum  starts  and  reaches 
its  maturity  at  the  onset  of  menstruation.  The 
governing  hormone  from  the  pituitary  is  called, 
Prolan  B,  and  the  corpus  lutein  hormone  is  called 
Progestin.  The  first  half  of  the  development  of 
the  endometrium  is  nonsecretory,  becoming  se- 
cretory under  the  luteinizing  hormone.  If  for 
any  reason  the  luteinizing  hormone  does  not  ap- 
pear then  there  will  be  no  secretory  development 
of  the  endometrium  and  a hyperplasia  with  some 
areas  of  focal  necrosis  results. 

HEMORRHAGE  DUE  TO  MALIGNANT 
CHANGES  IN  THE  MUCOSA  OF  THE  CER- 
VIX AND  BODY  OF  THE  UTERUS. 

It  is  common  sense  that  cancer  must  have 
some  starting  place  of  a few  cells  and  a true 
early  cancer  is  a microscopic  rather  than  a physi- 
cal fact.  Probably  no  human  organ  so  consist- 
ently exhibits  early  recognizable  signs  of  malig- 
nant disease  as  does  the  uterus  and  probably  no 
early  signs  are  so  consistently  ignored.  Very 
rare  indeed  does  malignant  disease  occur  with- 
out increased  and  irregular  hemorrhage;  this  is 


December,  1934] 


ARKANSAS  MEDICAL  SOCIETY 


I I I 


the  one  and  constant  symptom  and  occurs  early 
in  the  disease.  The  early  diagnosis  of  malignant 
disease  depends  upon  a number  of  factors.  One 
of  the  most  important  is  the  opportunity  given 
the  practitioner  by  the  patient  of  making  a com- 
plete investigation  immediately  when  any  signs 
or  symptoms  of  possible  malignant  disease  are 
noticed.  The  possibility  of  cure  of  carcinoma 
may  be  said  to  rest  on  the  date  at  which  it  is 
diagnosed;  for  the  earlier  it  is  treated,  either  by 
knife  or  radium,  the  better  for  the  patient. 

Carcinoma  of  the  cervix  is  generally  preceded 
by  some  damage  to  the  cervix  and  so  it  most 
commonly  occurs  in  parous  women.  There  is  no 
doubt  that  its  incidence  will  be  greatly  reduced 
if  every  woman  at  the  end  of  child-bearing  period 
has  her  cervix  examined  and,  if  necessary,  cau- 
terized or  repaired.  Carcinoma  of  the  body  of 
the  uterus  occurs  invariably  after  the  menopause 
and  often  in  unmarried  women,  while  that  of  the 
cervix  appears  at  an  earlier  age  and  generally 
among  parous  women.  It  is  here  we  get  the 
tragedy  of  the  mother  of  the  young  family  struck 
down  when  she  is  needed  most.  The  vaginal  por- 
tion of  the  cervix  is  covered  with  squamous  epi- 
thelium while  the  cervical  canal  is  lined  with  the 
high  cylindrical  mucosa  that  produces  the  mucous 
plug  in  pregnancy.  Carcinoma  may  develop 
from  any  of  these  types  of  glands. 

Squamous  Cell  Carcinoma  of  the  Cervix. — 
In  the  late  stages  this  is  easily  recognized  as  the 
"cauliflower"  type  of  carcinoma.  When  we  find 
this  condition  we  usually  see  the  entire  cervix 
and  surrounding  vagina  a mass  of  carcinomatous 
extension.  In  recent  years  these  cases  have  be- 
come less  numerous.  We  are  seeing,  due  to  in- 
creased education  along  these  lines,  numerous 
cases  in  which  our  facilities  are  taxed  to  deter- 
mine whether  the  case  is  one  of  the  carcinoma 
or  not.  I treat  these  patients  as  a problem  to 
which  the  answer  is  carcinoma.  If  I am  proved 
wrong,  I feel  that  I have  erred  on  the  side  of 
safety  for  them.  If  they  are  treated  as  though 
non-malignant  until  proven  so,  many  lives  will  be 
needlessly  sacrificed.  Any  woman  that  presents 
herself  is  entitled  to  a thorough  examination;  the 
cervix  being  treated  with  Lugol's  solution,  and  if 
suspicious  after  this,  a biopsy  should  be  made. 
A biopsy  under  the  electrical  knife  is  best  but  if 
you  do  not  have  that  advantage,  then  with  the 
ordinary  knife.  Do  not  be  satisfied  with  one 
biopsy  if  you  still  feel  that  there  are  some  areas 
of  carcinoma  present.  Sedimentation  time  with 
a complete  blood  count,  are  also  of  some  aid. 

Adeno-Carcinoma  of  the  Cervix. — Beginning 


in  the  cervical  canal,  it  is  the  most  malignant 
of  all  malignancies  and  fortunately  the  rarest. 
Unless  it  has  grown  down  into  the  external  os 
it  v/ill  not  be  seen  on  vaginal  examination. 

Adeno-Carcinoma  of  the  Body  of  the  Uterus. 
This  can  be  diagnosed  only  by  a curettage.  One 
should  not  hesitate  to  do  a diagnostic  curettage 
and  have  the  scrapings  examined  by  a compe- 
tent pathologist.  It  is  only  by  such  means  that 
the  proper  diagnosis  and  treatment  can  be  in- 
stituted. 

Carcinoma  will  rarely  be  overlooked  by  the 
man  who  has  "carcinoma  on  the  brain."  There 
are  few  doctors  today  who  do  not  know  that 
abnormal  bleeding  or  discharge  at  middle  life 
may  mean  carcinoma;  yet  many  of  them,  not 
from  ignorance,  but  from  apathy  and  lack  of 
thoroughness,  delay  in  instituting  proper  treat- 
ment at  the  proper  time. 

HEMORRHAGES  DUE  TO  PRESENCE  OF 
UTERINE  TUMORS. — Here  we  find  the  common 
fibroid.  It  is  usually  interstitial  at  the  beginning 
and  gradually  grows.  This  growth  may  be  to- 
ward the  mucosa  or  serosa.  If  to  the  mucosa, 
we  find  it  projecting  into  the  cavity  of  the  uterus 
and  causing  severe  hemorrhages.  If  it  grows  the 
other  way,  it  is  usually  pedunculated  and  rarely 
causes  the  severe  hemorrhages  that  the  other 
does.  Under  this  classification  we  find  the  ade- 
no-myoma.  The  muscular  wall  here  is  trans- 
formed into  a hard,  coarse,  diffuse  mass.  Rarely 
do  these  undergo  sarcomatous  degeneration. 

HEMORRHAGES  DUE  TO  ADNEXAL  DIS- 
EASE.-— We  find  it  in  purulent  salpingitis  and 
it  must  be  differentiated  from  unruptured  tubal 
pregnancy.  The  Friedman  test  assists  in  the 
diagnosis.  The  ovaries  are  usually  secondarily 
involved  with  the  tubes  and  the  entirety  is  one 
mass.  Ovarian  cysts  and  tumors  are  differen- 
tiated by  a bimanual  examination. 

DISCUSSION 

H.  W.  HUNDLING,  Little  Rock:  Dr.  Jones  has  given 

us  an  excellent  outline  of  the  various  causes  of  uterine 
hemorrhage  but  has  not  had  time  to  go  into  the  details 
of  the  diseases  which  cause  bleeding. 

One  of  these,  under  the  heading  of  constitutional 
diseases,  is  the  so-called  thrombocytopenic  purpura,  which 
is  very  frequently  misdiagnosed  and  mistreated  because 
a careful  blood  count  is  not  made.  In  the  majority  of 
the  cases,  a typical  blood  picture  will  give  you  a clue  to 
the  diagnosis;  but  because  of  the  fact  that  the  bleeding 
may  occur  from  the  nose  or  from  the  bladder  or  from 
the  intestinal  tract,  it  is  frequently  forgotten  that  the 
bleeding  may  occur  from  the  uterine  cavity.  This  type 
of  case  is  frequently  treated  badly  because  repeated 
curettements  may  be  done  without  improvement  before 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  7 


I 12 


the  condition  is  recognized.  Later  on,  radium  may  be 
used  with  similar  results.  There  is  only  one  positive  cure 
for  this  type  of  case,  namely  splenectomy. 

If  we  rule  out  malignancy  either  by  biopsy  or  curette- 
ment,  and  we  know  we  are  dealing  with  a case  of  func- 
tional bleeding,  then  we  have  an  entirely  different  pic- 
ture. Functional  bleeding,  of  course,  may  come  on  at 
any  time.  In  50  per  cent  of  the  cases  it  is  at  or  near 
the  menopause,  in  about  5 or  10  per  cent  at  puberty, 
and  in  about  5 per  cent,  bleeding  may  come  on  at  any 
time.  So,  we  may  try  the  various  ovarian  and  thyroid 
preparations  we  receive  in  the  mail  every  day,  but  fre- 
quently there  is  no  improvement. 

It  is  well  to  consider  some  of  these  cases  as  cases  of 
hypothyroidism,  although  the  metabolic  rate  frequently  is 
normal.  If  you  rule  out  any  pelvic  pathology,  especially 
in  the  young,  and  the  patient  continues  to  bleed,  it  is 
worth  while  to  try  this  treatment. 

In  some  recent  work  which  Dr.  Jones  mentioned,  a 
luteinizing  substance  obtained  from  the  urine  of  preg- 
nant women  has  been  used  in  cases  of  functional  bleed- 
ing with  great  benefit.  We  now  know  that  there  are 
five  hormones  which  have  been  isolated  from  the  pitui- 
tary gland  having  a great  bearing  on  this  type  of  bleed- 
ing. The  preparation  that  is  probably  the  most  satis- 
factory is  antuitrin,  and  we  have  had  some  excellent 
results  with  it. 

To  illustrate  this  very  nicely,  we  had  a patient,  a young 
married  woman  24  years  of  age,  who  had  normal  periods 
until  three  years  ago.  At  that  time  her  periods  became 
very  profuse;  in  fact,  she  bled  continuously  for  three 
years.  Last  fall  a curettement  was  done  elsewhere  with 
no  benefit  whatsoever,  and  she  continued  to  bleed.  We 
recently  put  her  on  antu'trin  and  after  six  administrations 
the  periods  became  normal.  She  went  two  or  three  weeks 
without  any  flow  and  since  that  time  the  periods  have 
been  perfectly  normal  and  she  has  had  no  trouble.  So, 
if  the  thyroid  preparations  do  not  work,  it  certainly  is 
worth  while  to  use  the  antuitrin. 

In  cases  of  advanced  malignancy  of  the  cervix,  we 
have  about  reached  our  limit  as  far  as  treatment  is 
concerned.  But  the  early  cases  may  be  diagnosed,  as 
Dr.  Jones  brought  out,  by  the  use  of  the  Lugols  solution  as 
advocated  by  Schiller.  I have  some  slides  to  show  the 
value  of  that  particular  test,  if  the  case  is  seen  early. 

J.  S.  RINEHART,  Camden:  Perhaps  it  would  be  bet- 

ter that  I had  kept  my  seat,  but  I am  one  of  those  rare 
doctors  known  as  the  family  doctor.  There  are  a few 
left,  and  there  are  going  to  be  some  family  doctors  as 
long  as  there  are  famiiles,  notwithstanding  the  literature 
of  the  last  two  years  to  the  contrary.  There  is  nothing 
so  simple  to  the  laity.  There  is  a uterine  hemorrhage. 
There  is  a loss  of  blood  from  the  uterus.  They  call  in 
the  doctors.  There  is  nothing  to  them  that  seems  so 
simple  but  that  the  doctor  should  at  once  divine  the 
cause,  apply  the  remedy  and  the  trouble  would  stop. 
But  Dr.  Jones,  with  five  things  on  that  hand  and  five  on 
this  hand,  went  into  some  of  the  details  as  to  the  cause 
of  uterine  hemorrhage.  A simpler  classification  of  uterine 
hemorrhage,  perhaps,  would  be  those  cases  in  which  we 
can  find  the  cause  and  those  cases  in  which  we  can  not 
find  the  cause.  I wish  and  I hope  that  this  afternoon  Dr. 
Bethea,  of  New  Orleans,  in  his  paper  on  Newer  Develop- 
ments of  Physical  Diagnosis  will  elicit  the  means  by  which 
this  simple  diagnosis  can  be  made  of  uterine  hemorrhage. 
Today  X-rays  are  made  of  the  interior  of  the  stomach, 
endoscopic  examinations  made  of  all  the  cavities,  but  I 


doubt  if  there  can  be  a picture  taken  of  the  inside  of 
the  uterus  or  whether  an  endoscopic  examination  can  be 
made.  Take,  for  instance,  a uterine  tumor  that  simulates 
in  every  way  the  picture  of  a beginning  extra-uterine 
pregnancy.  If  there  could  be  a way  to  see  the  little 
tumor  on  the  inside  of  the  uterus  and  make  a diagnosis, 
you  would  save  a lot  of  worry  and  anxiety.  I hope  that 
the  day  will  not  be  far  off  when  we  can  have  an  exami- 
nation made  that  is  as  simple  as  we  now  have  with  the 
bivalve  speculum  in  the  vagina,  whereby  we  can  explore 
practically  the  inside  of  the  uterus. 

DR.  JONES,  in  response:  I wish  to  thank  Dr.  Hundling 
and  Dr.  Rinehart  for  their  discussion.  We  all  see,  as  Dr. 
Rinehart  has  said,  many  cases  in  which  the  diagnosis  is 
most  difficult.  In  these  we  must  make  use  of  all  our 
diagnostic  facilities  and  even  then  we  may  be  at  a loss 
to  account  for  the  bleeding.  The  more  difficult  the  prob- 
lem, the  more  pleasure  we  get  from  its  solution  and  we 
should  consider  these  cases  in  that  respect. 

— 

DOCTORS,  DOLLARS,  AND  DISEASE 


Many  of  our  profession  have  recently  received  a little 
booklet,  telling  of  an  "educational"  venture  by  the  Na- 
tional Advisory  Council  on  Radio  in  Education.  This 
series  of  lectures  is  to  be  broadcast  to  the  nation  and 
can  also  be  had  for  a smalll  sum  of  money. 

We  concede  the  necessity  of  education  in  medical 
economics  and  would  applaud  any  impartial  instruction 
or  even  debate  on  topics  concerned  with  private  practice 
and  wilh  compulsory  health  insurance.  We  would  par- 
ticularly recommend  report  concerned  with  the  economic 
aspect  of  the  cost  of  community  health  insurance  to  the 
taxpayer.  We  would  like  to  hear  discussed  by  compe- 
tent authorities  who  know  American  physicians  as  we  do, 
what  effect  such  a program  would  have  on  the  way  gov- 
ernment employees  would  vote,  and  what  the  effect  of 
their  common  interest  in  the  taxpayer's  money  would  do 
to  the  taxpayer.  But  the  schedule  consists  of  nineteen 
lectures  by  nonmedical  men  who  want  to  tell  medicine 
how  to  "carry  on."  Of  the  seven  speakers  who  are  physi- 
cians, two  are  avowed  protagnosists  of  health  insur- 
ance; one  is  a president  of  a university  which  graduates 
doctors  of  medicine  and  runs  a pay  clinic  in  competi- 
tion with  them;  and  a fourth  is  a former  president  of  the 
American  Health  Association  whose  interests  have  al- 
ways been  in  that  sphere.  Actually  there  is  but  one  of 
the  physicians  selected  who  by  any  stretch  of  the  imagi- 
nation can  be  termed  a representative  of  the  viewpoint 
of  practicing  physicians. 

The  majority  of  the  lecturers  are  directly  associated 
with  foundations  actively  working  for  compulsory  health 
insurance.  Three  are  officials  of  hospital  associations  and 
the  remaining  five  embrace  a public  health  nurse,  a 
journalist,  two  investigators  in  the  field  of  public  health 
and  a professor  of  industrial  relations. 

The  medical  profession  should  make  its  protest  felt 
against  this  misuse  of  the  educational  function  which  the 
Federal  Radio  Commission  has  placed  in  the  hands  of 
this  National  Council  on  Radio  Education. — N.  Y.  St.  J. 
M„  Nov.  I,  1934. 

<$> 

ERRATUM 


In  the  membership  roster  of  Faulkner  County  Medical 
Society  the  name  of  Dr.  Lyle  L.  Hassell  incorrectly  ap- 
pears as  'Russell." 


December,  1934] 


ARKANSAS  MEDICAL  SOCIETY 


I 13 


AGRANULOCYTIC  LEUKOPENIA 
With 

MULTIPLE  PERIPHERAL  NEURITIS* 

FRANCIS  J.  SCULLY,  M.  D. 

Hot  Springs  National  Park 

The  following  case  of  agranulocytic  leukopenia 
is  interesting  because  of  the  development  of  a 
multiple  peripheral  neuritis  during  the  course  of 
the  disease.  I have  not  been  able  to  find  a 
similar  case  reported  in  the  literature. 

CASE  HISTORY 

C.  H.  W„  a male,  aged  57  years,  was  seen  January 
25,  1934,  complaining  of  weakness,  exhaustion,  a rapid 
beating  of  the  heart,  and  sore  throat.  His  illness  had 
started  with  sore  throat  three  weeks  previously.  There 
had  been  a rise  of  temperature  as  high  as  100°.  During 
the  past  four  days,  the  heart  rate  became  very  rapid, 
ranging  as  high  as  120.  There  was  also  some  numbness 
and  weakness  in  the  hands  and  difficulty  in  their  use. 
There  was  no  history  of  any  previous  illness  other  than 
influenza  in  1918. 

Examination  revealed  a fairly  well  nourished  male  who 
appeared  quite  ill.  Tongue  was  heavily  coated.  Throat 
was  acutely  congested.  Tonsils  were  large  and  inflamed. 
No  membrane  was  present.  The  cervical  glands  were 
only  slightly  enlarged.  Temperature  99.4°,  pulse  120, 
blood  pressure  106-68.  The  heart  tones  were  clear  but 
distant.  The  lungs  were  normal.  The  abdomen  showed 
the  liver  enlarged,  tender,  and  palpable  three  inches  be- 
low the  costal  margin.  The  spleen  was  not  palpable.  The 
deep  reflexes  were  normally  active  but  there  was  dimin- 
ished tactile,  pain,  and  temperature  sense  in  both  legs 
extending  to  the  knees  and  in  both  arms  extending  to  just 
above  the  wrists. 

The  blood  count  showed  60  per  cent  hemoglobin, 
3,180,000  red  cells  and  1750  white  cells.  The  differential 
count  showed  63  neutrophiles,  of  which  twenty  were  of 
the  immature  type,  31  small  lymphocytes  and  6 eosinophils. 
The  urine  specimen  was  normal. 

He  was  given  15  grains  sodium  salicylate  after  meals 
and  20  minims  digitalis  each  four  hours.  He  was  also 
given  I cc.  of  a nonspecific  lipoprotein  hypodermically 
daily  for  four  days,  then  pentnucleotide  intramuscularly. 
This  was  repeated  10  cc.  each  evening  and  5 cc.  each 
morning  for  five  days  and  then  once  a day  until  a total 
of  120  cc.  were  given.  By  February  16th,  there  was  im- 
provement in  his  condition  and  the  salicylate  and  digi- 
talis were  omitted.  A tonic  and  a liver  extract  prepara- 
tion were  started  at  that  time  and  have  been  continued 
more  or  less  regularly  since. 

With  the  treatment,  there  was  a gradual  clearing  up 
of  the  inflammatory  condition  of  the  throat.  The  tem-\ 
perature  ranged  lower  and  dropped  to  normal  on  Febru- 
ary 16th.  The  pulse  gradually  became  more  steady  and 
on  February  16th  it  was  80. 

On  January  28th  the  white  count  had  dropped  to 
1350.  The  differential  count  showed  44  neutrophiles,  12 
of  which  were  of  the  immature  type,  49  small  lymphocy- 
tes and  7 eosinophils.  With  the  use  of  the  pentnucleo- 
tide, there  was  a decided  improvement  in  the  white  count 
and  on  January  29th  it  was  2300,  on  January  31st  4450, 
February  2nd  800,  February  4th  3550,  February  6th  5500, 
February  7th  6880,  and  on  February  16th,  8150.  At  this 

* Submitted  for  publication  August  9,  1934. 


time  the  differential  count  showed  68  per  cent  neutro- 
philes with  8 immature  cells,  28  small  lymphocytes,  3 
transitionals  and  I eosinophil.  The  hemoglobin  was  80 
per  cent  and  red  cells  4,170,000.  On  March  15th,  the 
count  showed  84  per  cent  hemoglobin,  4,300,000  red  cells 
and  6250  white  cells  with  30  small  lymphocytes  and  70 
neutrophiles,  of  which  I was  immature. 

The  numbness  of  the  legs  and  hands  and  the  weak- 
ness of  the  extremities  gradually  became  more  marked 
and  on  February  16th  he  was  unable  to  use  the  hands  or 
to  stand  without  aid.  There  was  a marked  foot  and  wrist 
drop.  The  patellar  reflexes  were  absent.  There  was 
some  atrophy  of  the  small  muscles  of  the  hands  and  of 
the  calf  muscles.  During  the  early  part  of  his  illness,  he 
noted  some  aching  in  the  calf  muscles  and  some  cramp- 
ing in  the  hands,  but  this  gradually  subsided.  On  March 
26th  he  presented  a typical  picture  of  multiple  peri- 
pheral neuritis,  but  since  then  there  has  been  a gradual 
improvement.  The  sensation  has  returned  to  the  hands, 
and  to  a large  extent,  to  the  legs.  He  is  able  to  use 
the  hands  better  but  still  has  rather  marked  weakness 
of  the  ankles.  He  is  able  to. stand  but  requires  aid  inf 
walking. 

Comment 

Due  to  the  recent  attention  that  has  been 
given  to  the  action  of  the  barbiturates  and  ami- 
dyprine  preparations  on  the  white  count  and  in 
the  production  of  neutropenia  as  reported  by 
Madison  and  Squier  (I)  and  by  Hoffman  (2),  a 
careful  inquiry  was  made  into  the  treatment  this 
patient  had  received  previously  but  there  was 
no  history  of  the  use  of  any  of  these  prepara- 
tions. 

The  pentnucleotide  was  used  in  the  treatment 
of  the  neutropenia  because  of  the  favorable  re- 
sults that  had  been  reported  by  Jackson  and  his 
associates  (3)  and  because  of  the  lower  mortality 
rate  that  was  noted  by  Doan  (4)  in  comparison 
with  other  methods  of  treatment. 

This  case  presented  the  typical  findings  of  an 
agranulocytic  angina  but  was  unusual  because  of 
the  complicating  multiple  peripheral  neuritis. 
The  marked  inflammation  of  the  throat  was  evi- 
dently the  source  of  the  toxins  which  produced 
the  neutropenia,  while  at  the  same  time  affecting 
the  peripheral  nerves.  It  is  possible  that  if  the 
condition  had  been  recognized  earlier  and  treat- 
ment instituted  at  that  time,  the  damage  to  the 
peripheral  nerves  might  have  been  avoided. 

1.  Madison,  F.  W.,  and  Squier,  T.  L.:  The  Etiology  of 
Primary  Granulocytopenia  (Agranulocytic  Angina),  J.  A. 
M.  A.  102:  755-759  (March  10)  1934. 

2.  Hoffman,  M.  D.,  Butt,  E.  M.,  and  Hickey,  N.  G.; 
Neutropenia  Following  Amidypyrine,  J.  A.  M.  A.  102: 
1213  (April  14)  1934. 

3.  Jackson,  H.,  Parker,  F.,  Rinehart,  J.  F„  and  Taylor, 
F.  H.  L.;  Studies  of  Diseases  of  the  Lymphoid  and  Myeloid 
Tissues.  VI.  The  Treatment  of  Malignant  Neutropenia 
with  Pentose  Neucleotides,  J.  A.  M.  A.  97:  1436-1440 
(Mar.  14)  1931. 

4.  Doan,  C.  A.:  The  Neutropenic  State,  J.  A.  M.  A. 
99:  194-202  (July  16)  1932. 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  7 


I 14 


FIVE  UNUSUAL  PARALYTIC  CASES 
FOLLOWING  GASTRO-INTESTINAL 
DISTURBANCES* 

W.  B.  GRAYSON,  M.  D. 

State  Health  Officer 

and 

GORDON  HASTINGS,  M.  D. 

Assistant  State  Health  Officer 
Little  Rock 


On  December  27,  1933,  all  members  of  a 
negro  family  of  five,  living  on  a cotton  planta- 
tion in  southwestern  Arkansas,  became  acutely 
ill  with  signs  of  gastro-intestinal  disturbances.  In 
this  group  were  three  females,  ages  9,  I 5 and 
60  years;  two  males,  ages  12  and  25.  According 
to  the  history  all  of  these  patients  became  ill 
simultaneously,  complaining  of  nausea,  vomiting 
and  severe  abdominal'  cramps,  though  no  diar- 
rhea was  encountered.  For  economic  reasons 
and  because  of  remoteness  from  medical  facili- 
ties, a physician  was  not  summoned  during  the 
period  of  acute  illness.  As  symptoms  of  severe 
gastro-intestinal  irritation  disappeared,  repre- 
senting a latent  period  of  approximately  six 
days,  there  developed  among  the  group  a gen- 
eral feeling  of  improvement,  though  all  experi- 
enced a rapidly  progressing  sensation  of  numb- 
ness and  tingling  of  their  extremities.  Upon  at- 
tempting to  use  their  arms  and  legs  muscular 
weakness  was  apparent  which,  within  a period  of 
from  24  to  48  hours,  reached  its  height,  leaving 
all  five  patients  with  an  identical  flaccid  paraly- 
sis involving  all  extremities.  It  was  during  this 
alarming  stage  that  a physician  was  called. 

Believing  an  exogenous  poison  responsible,  a 
careful  inquiry  was  made  of  the  dietary  with 
results  essentially  unreliable,  though  it  was  said 
to  have  included  fresh,  thoroughly  cooked  pork, 
chitterlings,  chili,  biscuits,  candy,  apples  and 
"bubble"  chewing  gum.  The  older  of  the  two 
males  slaughtered  and  dressed  a hog  the  day 
following  Christmas,  and  to  this  animal  the  fam- 
ily attributed  all  responsibility  for  their  misfor- 
tune. A large  portion  of  the  meat  was  given 
neighbors  though  illness  was  confined  to  the  one 
family.  A neighborhood  rumor  among  the 
"darkies"  placed  guilt  on  the  negro  boy  for 
stealing  corn  to  fatten  his  hog  from  a white 
farmer  who,  repeatedly  missing  corn  from  his 
crib,  became  incensed,  and  in  order  to  assign 
responsibility  poisoned  some  of  the  corn  with 
arsenic.  An  investigation  failed  to  confirm  the 
rumor. 

* Submitted  for  publication  September  7,  1934. 


On  examining  these  patients  the  attending 
physician  was  of  the  impression  that  he  was 
dealing  with  a peculiar  malady  the  nature  of 
v/hich  he  was  quite  uncertain.  Consultation  was 
thus  sought  resulting  in  visits  by  a total  of  seven 
physicians,  including  a neurologist  and  the  auth- 
ors, the  latter  present  because  of  possibilities  of 
the  condition  being  a menace  to  public  health. 
Unfortunately,  the  patients  were  not  subjected 
to  complete  physical  examinations  until  twelve 
weeks  after  all  of  their  acute  symptoms  had  sub- 
sided. Most  regretful  was  the  failure  to  collect 
specimens  for  complete  laboratory  examination 
when  such  would  have  been  of  great  diagnostic 
value. 

Physical  examination  of  the  group  revealed 
the  special  senses  to  be  essentially  normal. 
There  was  no  endocrine  disturbance;  facial 
muscles  symmetrical;  no  deviation  of  tongue: 
eyes  showed  no  affection  of  extrinsic  muscles; 
pupils  equal,  regular  and  reacted  to  light  and 
distance;  Rhomberg  positive.  Limbs  showed  par- 
tial bilateral  paralysis  with  wrist  and  ankle  drop; 
atrophic  changes  in  all  muscles  of  extremities, 
particularly  the  thenar  group.  There  were  no 
marked  vaso-motor  changes,  neither  cyanosis, 
dermographia,  edema  nor  blotching.  The  upper 
and  lower  tendon  reflexes  were  absent.  With 
exception  of  the  extremities,  physical  findings 
were  generally  normal.  Spinal  fluid  and  blood 
sera  were  negative.  The  partial  paralysis,  defi- 
nitely flaccid,  was  without  diversified  localization, 
and  at  no  time  during  the  course  of  the  illness 
were  there  gradations  in  severity  of  any  of  the 
symptoms. 

Upon  studying  the  literature  we  have  been 
unable  to  discover  a similar  outbreak  affecting 
all  members  of  a family.  Multiple  cases  of  an- 
terior poliomyelitis  do  occur,  though  it  would 
be  quite  unusual  for  five  to  become  ill  at  the 
same  time  and  with  identical  severity.  There 
was  also  an  entire  absence  of  poliomyelitis  in 
this  area.  In  many  respects  these  cases  remind 
one  of  the  flaccid  paralysis  patients  encountered 
in  1930-31  when  the  intake  of  Jamaica  ginger 
contaminated  with  triorthocresyl  phosphate  was 
held  definitely  responsible.  One  physician  sug- 
gested the  possibility  of  botulism,  though  this 
may  be  dismissed  since  none  of  the  patients  de- 
veloped any  of  the  several  constant  findings 
characteristic  of  this  type  of  food  poisoning.  The 
probability  of  either  arsenic  or  lead  as  the  of- 
fending agent  must  be  considered,  though  at  no 
time  during  the  course  of  the  illness  did  any  of 
the  patients  show  uniform  evidence  of  these 
chemicals.  All  were  affected  during  Christmas 


December,  1934] 


ARKANSAS  MEDICAL  SOCIETY 


115 


at  a time  when  feasts  are  customary  and  placing 
of  responsibility  was  difficult. 

Being  impressed  with  the  potential  public 
health  importance  of  these  cases  and  the  urgen- 
cy of  establishing  a diagnosis  ,if  possible,  one 
of  us  (G.  H.)  sought  advice  from:  Doctors  G. 
W.  McCoy,  Director  of  the  National  Institute 
of  Health,  Simon  Flexner,  of  the  Rockefeller  In- 
stitute for  Medical  Research,  J.  P.  Leake,  Senior 
Surgeon  of  the  U.  S.  Public  Health  Service,  Ed- 
win O.  Jordan,  Professor  of  Bacteriology,  Uni- 
versity of  Chicago,  and  John  F.  Anderson,  Di- 
rector of  the  Biological  Department,  E.  R. 
Squibbs  & Son  and  Former  Director  of  the  Na- 
tional Institute  of  Health.  It  was  hoped  through 
this  correspondence  to  procure  the  trend  of 
thought  from  leading  authorities  and  insofar  as 
possible  hazard  a diagnosis.  Their  comments 
were  uniformly  in  favor  of  the  hypothesis  that 
a chemical  poison  of  a highly  specific  nature 
was  responsible  and  of  the  extreme  unlikelihood 
of  infantile  paralysis.  Dr.  M.  I.  Smith,  of  the 
Public  Health  Service,  to  whom  the  correspond- 
ence was  referred  by  Dr.  McCoy,  stated: 

"The  only  known  chemical  agent  that  can  ex- 
plain satisfactorily  all  of  the  above  points  is 
triorthocresyl  phosphate,  the  substance  which 
was  responsible  for  the  outbreak  of  ginger 
paralysis  in  1930-31.  The  only  point  that  re- 
mains to  be  explained  is  how  this  substance  could 
have  been  ingested  at  the  late  date  of  Decem- 
ber, 1933." 

<i> 

THE  INDISCRIMINATE  USE  AND  RENTAL 
OF  RADIUM 


Resolution  adopted  by  American  Radium  Society  at 
Annual  Meeting,  Cleveland,  June  12,  1934;  also  adopted 
by  American  College  of  Radiology,  June  12,  1934. 

WHEREAS  it  is  now  recognized  that  radium  has  been 
demonstrated  to  be  of  definite  value  in  the  treatment  of 
disease,  and 

WEIEREAS  some  States  and  many  communities  in  the 
country  have  little  or  no  radium  available,  and 

WHEREAS  funds  are  not  always  available  for  the  pur- 
chase of  suitable  preparations  of  radium  for  use  by  those 
physicians  who  are  qualified  in  radium  therapy,  and 
WHEREAS  we  recognize  that  radium  is  an  agent  quite 
as  potent  for  doing  harm  as  for  doing  good  when  used 
without  sufficient  skill  or  training  and  with  the  hope  of 
protecting  the  uniformed  public  from  serious  and  irre- 
parable injury  from  improper  and  insufficient  treatment. 

BE  IT  RESOLVED  that  we  consider  it  improper,  un- 
ethical and  detrimental  to  the  science  of  Radiology  and 
to  the  good  of  suffering  humanity  for  commercial  labora- 
tories to  attempt  to  give  advice  or  directions  as  to  the 
use  of  radium  in  the  case  of  a patient  whom  the  person 
giving  that  advice  has  not  even  had  the  opportunity  to 
examine.  In  other  words,  it  is  just  as  difficult  to  give 
such  advice  and  directions  as  it  would  be  for  a surgeon 


to  give  directions  for  the  use  of  rented  surgical  instru- 
ments so  that  an  untrained  physician  might  attempt  an 
operation.  Various  commercial  companies  advertise  both 
in  the  Journals  and  through  the  mails,  medical  advice  for 
the  purpose  of  making  sales  or  renting  radium  or  radon. 
This  places  these  corporations  in  the  field  of  practicing, 
medicine. 

BE  IT  RESOLVED  that  the  same  criticism  be  applied 
to  institutions  which  rent  or  furnish  their  radium  to  those 
members  of  their  staff  or  outside  of  the  staff  who  are 
unskilled  in  radium  application. 

RESOLVED  that  the  same  criticism  applies  to  many 
individual  ov/ners  of  radium. 

RESOLVED  that  we  regard  the  approval  of  the  Na- 
tional Board  of  Radiological  Examiners  as  the  minimum 
standard  for  those  assuming  the  responsibility  for  using 
radium.  We  recommend  as  wide  publicity  of  this  Board's 
existence  and  approval  as  is  possible  to  the  public,  con- 
sistent with  ethical  practices,  as  the  most  effective  safe- 
guard v/hich  can  be  afforded  them. 

RESOLVED  that  we  recommend  the  refusal  of  adver- 
tising matter  in  National  and  State  Journals  when  the 
companies  concerned  are  advertising  a Medical  Con- 
sulting Service  or  are  advertising  such  service  through 
the  mails  in  connection  with  their  sale  or  rental  of 
radium. 

RESOLVED  that  we  disapprove  of  any  doctor's  acting 
as  a Consultant  to  a commercial  company  carrying  on, 
such  a campaign  of  public  or  private  advertising  and 
that  we  consider  such  an  association  sufficient  grounds 
to  warrant  disbarment  from  the  approval  of  the  National 
Board  of  Radiological  Examiners. 

RESOLVED  that  we  recognize  the  ethical  commercial 
company  as  a necessity.  It  is  the  advertised  Consulting 
Service  that  is  at  fault.  It  is  recognized  that  such  re- 
strictions on  the  advertising  of  a Medical  Service  will 
in  no  way  hamper  properly  qualified  Radium  Therapists 
in  obtaining  adequate  supplies  of  radium  or  radon  for 
the  purposes  in  which  they  are  qualified  to  employ  it. 

RESOLVED  that  we  approve  an  informal  Medical  Con- 
sultant for  the  guidance  of  those  commercial  companies 
who  refrain  from  advertising  such  professional  service, 
either  publicly  or  privately  and  that  in  such  case  their 
informal  Consultant  be  one  approved  by  the  National 
Board  of  Radiological  Examiners. 


A DOCTOR  NEEDS  A GARDEN 


I VERA  BLOOD  FLETCHER 

i Hot  Springs  National  Park 

i (Reprinted  form  The  Denver  Post.) 

i.  Complaining  patients  fill  his  day 

And  most  of  them  too  poor  to  pay! 

1 But  far  away  from  office  clocks 

, He  olants  a garden  in  the  rocks; 

t Where  iris  bloom  so  straight  and  tall, 

i Wistaria  climbs  the  garden  wall. 

< No  white  coat  here!  His  old  blue  shirt 

, Is  torn  and  faded — streaked  with  dirt! 

1 But  as  he  trains  a climbing  rose 

, He  sees  a baby's  puckered  nose. 

1 A father's  thanks  ....  a mother's  smile 

i Are  things  that  make  his  day  worth  while. 

L — — ~ — 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  7 


I 16 


PRESIDENT'S  PAGE 


0 (Smttnga 

TO  THE  MEMBERS  OF  THE  MEDICAL  PROFESSION 
OF  ARKANSAS 

It  is  with  much  pleasure  that  I greet  you  on  the  coming  joyous 
occasion;  this  is  a season  of  the  year  that  is  marked  by  good  cheer 
and  good  will  toward  all  our  fellowmen  and  reminds  us,  as  medical 
men,  of  our  universal  duty  to  spread  health,  happiness  and  good 
cheer  to  all  mankind  and  especially  to  our  associates  in  medicine. 

It  is  also  a time  to  review  our  acts  of  the  past  twelve  months. 
Have  we  made  the  paths  of  the  sick  and  afflicted,  the  weary  and 
care-worn,  any  the  easier?  Has  our  advice  been  such  as  to  alleviate 
their  burdens,  have  we  been  sufficiently  diligent  in  our  efforts  to 
lighten  the  loads  of  those  unable  to  help  themselves? 

I have  enjoyed  in  no  small  measure  the  social  contacts  made  and 
the  splendid  scientific  programs  heard  at  the  different  meetings  which 
I have  been  privileged  to  attend,  and  feel  that  I have  been  greatly 
benefitted  by  them.  It  is  by  such  contacts  and  the  presentation  of 
these  programs,  that  we  will  become  better  organized,  better  able  to 
act  more  thoroughly  as  one  unit,  and  have  a greater  respect  and  higher 
regard  for  the  opinion  of  one  for  the  other.  When  we  shall  have 
reached  that  stage  of  tolerance  with  a co-operative  and  understand- 
ing sympathy  for  our  fellow  practitioner,  we  shall  have  reached  a 
stage  in  our  development  when  we  will  be  most  useful  in  our  relief 
of  the  sick  and  afflicted  and  those  most  needful  to  be  advised;  to 
such  a happy  end  we  strive. 

May  the  Supreme  Architect  of  the  Universe,  the  Giver  of  all 
good  and  perfect  gifts,  be  with,  guide,  and  protect  you  and  yours. 

Sincerely  yours, 

F.  O.  MAHONY,  M.  D.,  F.  A.  C.  P. 


December,  1934] 


ARKANSAS  MEDICAL  SOCIETY 


117 


THE  JOURNAL 

OF  THE 

ARKANSAS  MEDICAL  SOCIETY 


Owned  by  the  Arkansas  Medical  Society  and  Published 
under  direction  of  the  Council 


DR.  W.  R.  BROOKSHER,  Editor 
610  First  National  Bank  Bldg.,  Fort  Smith,  Arkansas 


The  advertising  policy  of  this  Journal  is  governed  by  the  rules 
of  the  Council  on  Pharmacy  and  Chemistry  of  the  American 
Medical  Association. 

All  communications  to  this  Journal  must  be  made  to  it  exclu- 
sively. Communications  and  items  of  general  interest  to  the  pro- 
fession are  invited  from  all  over  the  State.  Notice  of  deaths, 
removals  from  the  State,  changes  of  location,  etc.,  are  requested. 


OFFICERS  OF  THE  ARKANSAS  MEDICAL  SOCIETY 


F.  O.  MAHONY,  President  El  Dorado 

M.  E.  McCASKILL,  President-Elect  Little  Rock 

A.  M.  ELTON,  First  Vice-President  Newport 

S.  C.  FULMER,  Second  Vice-President  Little  Rock 

F.  D.  SMITH,  Third  Vice-President Blytheville 

R.  J.  CALCOTE,  Treasurer  Little  Rock 

W.  R.  BROOKSHER,  Secretary  Fort  Smith 


COUNCILORS 

First  District — W.  M.  MAJORS  Paragould 

Second  District — S.  J.  ALLBRIGHT  Searcy 

Third  District — M.  C.  JOHN  , Stuttgart 

Fourth  District — C.  W.  DIXON  Gould 

Fifth  District— L.  L.  PURIFOY  El  Dorado 

Sixth  District — DON  SMITH  Hope 

Seventh  District — GEO.  B.  FLETCHER  Hot  Springs 

Eighth  District — S.  B.  HINKLE  Little  Rock 

Ninth  District — D.  L.  OWENS  Harrison 

Tenth  District — S.  J.  WOLFERMANN  Fort  Smith 


COMMITTEES 

(Appointments  expire  in  the  year  indicated.) 

Scientific  Work — L.  L.  Purifoy,  Chairman,  El  Dorado  (1935);  R. 
B.  Robins,  Camden  (1936);  W.  R.  Brooksher,  Fort  Smith  (1937). 

Medical  Legislation — Val  Parmley,  Chairman,  Little  Rock 
(1937);  M.  L.  Norwood,  Lockesburg  (1937);  O.  L.  Williamson, 
Marianna  (1937);  H.  T.  Smith,  McGehee  (1936);  R.  L.  Smith, 
Russellville  (1936);  A.  S.  Buchanan,  Prescott  (1935);  H.  A.  Dish- 
ongh,  Little  Rock  (1935). 

Health  and  Public  Instruction — W.  B.  Grayson,  Chairman,  Little 
Rock  (1937);  S.  W.  Douglas,  Eudora  (1937);  B.  M.  Stevenson, 
Crawfordsville  (1937);  H.  K.  Carrington,  Magnolia  (1936);  H.  A. 
Stroud,  Jonesboro  (1936);  J.  H.  Fowler,  Harrison  (1935);  E.  J. 
Munn,  El  Dorado  (1935). 

Medical  Education  and  Hospitals — Joe  F.  Shuffield,  Chairman, 
Little  Rock  (1937);  David  Levine,  El  Dorado  (1936);  J.  B.  Futrell, 
Rector  (1935). 

Public  Relations — D.  A.  Rhinehart,  Chairman,  Little  Rock  (1937); 
E.  E.  Bariow,  Dermott  (1936);  M.  E.  McCaskill,  Little  Rock  (1935). 

Medical  Economics — I.  F.  Jones,  Chairman,  Fort  Smith  (1937); 
R.  B.  Robins,  Camden  (1937);  J.  E.  Neighbors,  Stuttgart  (1936); 
D.  E.  White,  El  Dorado  (1936);  Roy  Millard,  Dardanelle  (1935); 
A.  C.  Shipp,  Little  Rock  (1935);  R.  M.  Sloan,  Jonesboro  (1935). 

Scientific  Exhibit — F.  H.  Krock,  Chairman,  Fort  Smith  (1935); 
H.  King  Wade,  Hot  Springs  National  Park  (1936);  W.  E.  Gray 
Jr.,  Little  Rock  (1937). 

Arrangements — (Host  Society  1935  meeting)— D.  W.  Goldstein, 
Chairman,  C.  S.  Holt,  J.  A.  Foltz,  H.  Moulton,  M.  E.  Foster, 
W.  G.  Eberle,  I.  F.  Jones. 

Necrology — W.  H.  Mock,  Chairman,  Prairie  Grove  (1935)-  J. 
M.  Lemons,  Pine  Bluff  (1936);  H.  Moulton,  Fort  Smith  (1937)'. 

Auxiliary— L.  J.  Kosminsky,  Chairman,  Texarkana  (1935);  W.  T. 
Wootton,  Hot  Springs  National  Park  (1936);  C.  S.  Holt  Fort 
Smith  (1937). 


Cancer  Control — D.  W.  Goldstein,  Chairman,  Fort  Smith  (1937); 
R.  L.  Saxon,  Little  Rock  (1936);  L.  A.  Purifoy,  El  Dorado  (1935). 


The  Journal  extends  the  Season's  Greetings  to 
the  members  of  the  Arkansas  Medical  Society, 
its  advertisers  and  exchanges,  and  wishes  all 
health,  happiness  and  prosperity  in  1935. 


EDITORIAL 


ELECTION  OF  OFFICERS 

During  this  month  the  majority  of  the  county 
medical  societies  will  elect  officers,  a most  im- 
portant privilege  of  the  membership.  Too  much 
emphasis  cannot  be  placed  upon  the  necessity 
for  selecting  interested,  active  and  willing  mem- 
bers for  all  official  positions.  This  is  especially 
true  in  these  times  when  the  full  strength  of 
organized  medicine  must  be  maintained  in  order 
that  the  many  pressing  problems  of  the  pro- 
fession may  be  courageously  met  and  satisfac- 
torily solved.  Developments  of  the  past  year 
have  shown  that  individual  effort  will  not  serve 
for  the  solution  of  these  problems,  but  many  of 
them  can  be  met  successfully  if  the  individual 
effort  is  coordinated  with  that  of  the  group  into 
organized  activity.  Obviously,  physicians  will 
be  tremendously  handicapped  unless  they  are 
properly  organized  and  their  county  societies 
function  at  a peak  efficiency.  The  county  medi- 
cal society  which  lacks  aggressive  and  judicious 
leadership  is  destined  for  a record  devoid  of 
accomplishment  and  such  influence  as  it  may 
exert  may  even  be  destructive  to  the  best  ideals 
of  medical  organization. 

Election  of  officers  is  a serious  obligation.  It 
is  not  the  occasion  for  the  passing  around  of 
honors  but  rather  the  opportunity  by  which  those 
who  are  qualified  and  willing  to  serve  may  be 
made  available  for  the  leadership  which  is  so 
urgently  needed  today. 


SICKNESS  INSURANCE 

Members  of  the  Arkansas  Medical  Society  are 
urged  to  carefully  read  the  American  Medical 
Association  bulletin  appearing  elsewhere  in  this 
issue.  This  deals  with  sickness  insurance  and  in- 
dicates the  thoroughness  of  the  campaign  which 
the  proponents  of  this  plan  of  medical  care  are 
waging  in  their  efforts  to  force  the  system  upon 
the  people  of  the  United  States.  The  Journal 
believes  that  most  of  the  citizens  of  this  nation 
would  resent  any  system  which  would  deprive 
them  of  the  right  of  free  choice  of  a physician. 
Certain  it  is  that  present  experience  with  medi- 
cal care  under  governmental  regulation  has 
proved  anything  but  a boon  to  the  private  prac- 
titioner; it  is  unlikely  that  a more  complete  exten- 
sion of  the  plan  would  prove  satisfactory  to 
even  a small  minority  of  physicians.  Space  does 
not  permit  a discussion  of  sickness  insurance,  or 
of  state  medicine.  Opinion  of  those  outside  of 
medical  organization  has  been  forcibly  stated  in 
a periodical  which  is  itself-  opposed  to  medical 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  7 


therapy.  The  tentative  plan  of  'state  medicine' 
as  recently  outlined  by  the  Milbank  Memorial 
Fund  proposes  that  the  American  population, 
including  62  per  cent  which  the  fund's  spokes- 
man says  receive  no  medical,  dental  or  eye  care 
of  any  kind,  shall  be  coerced  into  supporting 
financially  and  yielding  physically  to  the  domina- 
tion of  a group  of  state-employed  men.  It  is 
difficult  to  understand  why  every  citizen  * * * * 
should  be  compelled  to  comply  with  such  a regu- 
lation. Incidentally,  it  is  strangely  foreign  to  the 
legend  of  the  family  doctor,  who  worked  under 
the  motto,  'To  each  according  to  his  need;  from 
each  according  to  his  means.'  The  source  of 
this  desire  for  state  medicine  is  not  the  medical 
profession.  Its  members  have  not  sought  this 
process  of  regimentation.  The  profession  will 
not  be  regimented  if  each  member  will  do  that 
which  he  rather  passively  hopes  will  be  done  for 
him  by  others;  take  steps  to  arouse  public  opin- 
ion, each  in  his  own  circle  of  contacts.  (Boldface 
ours — Ed.)  The  very  confidence  which  the  in- 
dividual physician  arouses  in  his  patients,  will, 
in  the  aggregate,  prove  the  greatest  menace  to 
this  insidious  propaganda.  In  addition  to  indi- 
vidual effort,  organized,  co-operative  measures 
are  essential.  Organized  medicine  has  a poten- 
tial influence  sufficient  to  drive  its  opponents  to 
cover.  Whatever  may  be  the  outcome  of  this 
campaign  to  institute  state  medicine,  the  result 
will  be  chargeable  to  the  profession;  its  defeat, 
to  co-operative  intelligent  activity;  its  establish- 
ment, to  a greater  or  lesser  passivity.  The  re- 
sponsibility is  direct;  the  challenge  clear.  The 
medical  profession  must  solve  medical  problems; 
it  alone  has  the  intimate  knowledge  which  can 
furnish  an  intelligent  and  happy  solution."  The 
Journal  commends  these  thoughts  to  you  for 
your  individual  and  organized  effort. 

<t> 

EDITORIAL  COMMENT 


Of  general  interest  to  physicians  who  are 
rendering  service  to  persons  on  relief  rolls  is  the 
opinion  of  legal  counsel  regarding  liability  in- 
curred by  such  a physician  who  declines  to 
further  treat  a person  for  whose  treatment  no 
additional  authorization  is  furnished  by  the  relief 
administration.  The  opinion  follows:  "If  a physi- 
cian finds  it  desirable  to  withdraw  from  a case, 
he  must  give  the  patient  reasonable  opportunity 
to  secure  other  medical  service.  Cases  have 
gone  to  our  Supreme  Court  where  a physician, 
during  the  course  of  treatment,  learned  he  could 
not  expect  payment;  he  advised  the  patient  that 
provision  must  be  made  for  his  remuneration  or 


he  would  withdraw  after  reasonable  notice,  and 
it  was  held  that  the  physician  was  within  his 
rights.  A physician  is  not  required  under  our 
laws  to  give  his  services  gratis  merely  because 
he  has  performed  some  services  in  the  case." 


The  recent  perusal  of  a leading  British  medical 
journal1  has  afforded  an  insight  into  some  of  the 
difficulties  of  the  panel  practice  of  medicine  in 
England.  In  this  one  issue  are  discussed  the  legal 
action  of  one  physician  against  another  arising 
from  alleged  slanderous  statements  of  the  second 
physician  in  his  attempts  to  secure  removal  of 
the  first  physician's  patients  to  his  panel.  Dam- 
ages in  the  amount  of  fifty  pounds  were  award- 
ed the  aggrieved  doctor.  There  is  a spirited 
editorial  on  the  growing  habit  of  hotel  keepers 
and  the  like  who  have  endeavored  to  induce 
employees  to  change  from  their  chosen  prac- 
titioner to  the  physician  serving  the  hotel.  Illus- 
trative of  the  manifold  "paper"  technicalities  of 
the  insurance  act  is  the  account  of  the  physician 
who  was  called  in  an  emergency  to  see  the  pa- 
tient of  another  physician  whose  telephone  was 
busy  and  thus  he  could  not  be  called.  In  this 
instance,  the  second  practitioner  was  obliged  to 
present  his  bill  for  services  first  to  the  local  panel 
committee,  v/ho  rejected  it  on  the  grounds  that 
sufficient  effort  had  not  been  made  to  obtain 
the  customary  physician  of  that  family.  On  ap- 
peal to  the  national  panel  board,  the  practition- 
er's right  to  the  emergency  fee  was  sustained. 
To  obtain  this  small  fee  it  was  therefore  neces- 
sary for  the  physician  to  appear  before  a govern- 
ing committee  on  two  occasions,  with  what  loss 
of  time  and  expense  we  may  guess.  In  a second 
case  recounted,  a physician  was  called  to  see  a 
dying  patient.  Events  subsequently  showed  that 
the  regular  practitioner  had  called  only  a short 
time  previously,  assuring  the  family  that  nothing 
could  be  done  and  had  departed.  The  second 
physician,  unfamiliar  with  this  state  of  affairs, 
had  made  an  emergency  call  in  good  faith.  The 
question  of  the  payment  of  fee  was  argued 
through  both  panel  committees  with  final  re- 
jection. 

1 Lancet,  July  7,  1933. 


No  less  an  author  than  Rex  Beach  has  turned 
out  what  is  most  appealing  copy  favoring  the 
newest  contribution  to  faith  healing — Mahlon 
Locke.  This  article,  appearing  in  a periodical 
of  popular  distribution,  is  in  the  nature  of  a 
follow-up  study  of  opinions  formed  on  a visit 
two  years  previously.  It  has  apparently  caused 
the  gullible  American  public  to  trod  well  the 


December,  1934] 


ARKANSAS  MEDICAL  SOCIETY 


I 19 


path  to  the  doors  of  their  newest  mystic  shrine 
of  health.  This  same  author,  well-remembered 
for  his  virile  works,  as  The  Ne-er-do-Well,"  it 
may  be  parenthetically  remarked,  has  stated  in 
testimonial  form  that  a certain  popular  cigarette 
restores  the  energy  which  he  loses  after  an  en- 
counter with  a game  fish.  It  is  to  wonder  if  he 
■carried  an  .extra  supply  of  fhis  brand  across  the 
customs  when  planning  this  second  series  of  in- 
terviews. 

Locke's  treatment,  we  are  informed,  consists 
in  the  simultaneous,  perhaps  we  should  say  suc- 
cessive, receipt  of  a dollar  bill  and  the  patient's 
feet;  the  dollar  bill  to  Locke's  pocket,  the  feet  to 
his  lap.  The  feet  are  bent  downward  and  out- 
ward and  the  patient  moves  on,  cured  or  re- 
lieved, we  are  led  to  believe,  of  arthritis,  in- 
fantile paralysis,  anklyosed  spines,  and  blindness, 
which  according  to  time-honored  formula,  could 
not  be  cured  by  medical  science.  It  is  obvious 
that  barring  possible  benefit  such  as  might  be 
received  from  a masseur,  the  treatment  is  en- 
tirely psychologic  with  the  added  therapeutic 
benefit  of  the  "laying-on-of-hands."  To  quote 
Morris  Fishbein  (I):  "The  activities  of  Dr.  Locke 
are  a burlesque  on  the  scientific  practice  of  med- 
icine. His  promotion  is  a violation  of  every  tra- 
ditional, ethical  tenet!  There  are  some  who  say 
that  even  psychologic  relief  for  the  chronic 
arthritic  patient  is  worth  while,  regardless  of  the 
means  by  which  it  is  accomplished.  The  reac- 
tion on  the  scientific  practice  of  medicine  and 
the  chagrin  and  disappointment  of  those  seri- 
ously sick  do  not  permit  this  laissez  faire  atti- 
tude. Moreover,  many  a person  who  might  be 
benefitted  by  scientifically  applied  physical  ther- 
apy and  by  competent  orthopedic  surgery  is 
spending  hard-earned  money  to  make  the  long 
trek  to  Williamsburg  in  search  of  a pot  of  gold 
which  those  at  the  end  of  the  rainbow  are  con- 
sistently saving  for  themselves." 

I — J.  A.  M.  A.,  October  13,  1934. 

■ <$> 

LILLY  RESEARCH  LABORATORIES 
FORMALLY  OPENED 

More  than  a thousand  investigators  and  research  work- 
ers were  present  at  the  formal  opening  of  the  new  Lilly 
Research  Laboratories  at  Indianapolis  on  October  II. 
At  the  formal  opening  exercises,  in  the  afternoon,  Eli 
Lilly,  head  of  the  Lilly  organization,  presided  as  chair- 
man. Mr.  J.  K.  Lilly,  chairman  of  the  board  of  directors, 
was  introduced  and  responded  briefly  on  "Research  in; 
Manufacturing  Pharmacy."  Following  Mr.  Lilly's  remarks, 
Dr.  Irving  Langmuir,  director  of  research  for  the  Generali 
Electric  Company,  discussed  "The  Unpredictable  Resuits 
of  Research."  The  speaker  stressed  the  point  that  funda- 
mental  research  should  be  pursued  by  industrial  corpora- 
tions regardless  of  any  immediate  possible  commercial 
return  therefrom. 


Sir  Frederick  Banting  then  talked  on  "The  Early  His- 
tory of  Insulin."  He  gave  an  account  of  the  early  ex- 
periments conducted  by  Dr.  Best  and  himself  which  first 
demonstrated  the  existence  of  Insulin,  and  expressed  his 
great  appreciation  of  the  co-operation  which  he  and  his 
associates  had  received  from  the  staff  of  the  Lilly  Re- 
search Laboratories  in  the  development  of  a practical, 
large-scale  procedure  for  the  production  of  Insulin. 

Sir  Henry  Dale,  director  of  the  National  Institute  for 
Medical  Research,  London,  and  secretary  of  the  Royal 
Society,  spoke  of  the  immediate  objectives  of  research 
in  such  laboratories  as  those  of  Eli  Lilly  and  Company, 
and  of  their  natural  and  proper  differences  from  those 
of  the  laboratories  supported  by  academic  or  public  en- 
dowment. It  was  his  thought,  however,  that  the  differ- 
ences in  result  for  the  progress  of  medical  science  are 
often  more  formal  than  real. 

According  to  Sir  Henry,  the  change  that  has  taken 
place  in  the  scope  of  pharmacy  has  a revolutionary  as- 
pect. He  cited  the  fact  that  pharmacy  not  very  many 
years  ago  was  predominantly  concerned  with  the  tradi- 
tional drugs  that  had  come  into  use  through  empirical 
observation.  Even  though  with  the  years  had  come  new 
additions  from  time  to  time,  the  therapeutic  outlook  and 
attitude  had  changed  but  little  for  centuries. 

"The  transformation  of  the  whole  aspect  of  one  disease 
by  the  discovery  of  Insulin  has  attracted  a more  general 
attention,"  said  the  speaker,  "than  almost  any  other  ad- 
vance in  medical  science  within  our  time."  He  was  of 
the  opinion  that  this  discovery  might  be  considered  in- 
dicative of  the  wider  progressive  change  in  therapeutic 
method,  based  upon  new  knowledge  of  the  causes  of 
disease  and  aiming  at  the  removal  of  those  causes. 

The  speaker  expressed  the  thought  that  looking  at  the 
change  as  a whole,  one  might  distinguish  two  main  con- 
tributory factors. 

The  first  of  these  was  the  recognition  of  infections  as 
due  to  the  invasion  of  the  body  by  living  micro-organ- 
isms. It  is  a commonplace,  he  said,  that  preventive 
medicine  was  born  of  this  discovery,  that  it  gave  a new 
direction  to  the  therapeutics  of  infective  diseases,  in  the 
search  for  remedies  specifically  killing  or  limiting  the 
growth  of  the  infecting  micro-organisms  or  specifically 
neutralizing  the  poisons  which  they  produce  in  the  in- 
fected body.  A few  of  the  older  remedies,  indeed,  ac- 
cording to  the  speaker,  owed  their  value  to  an  uncon- 
scious application  of  such  specific  actions  for  the  control 
of  infective  organisms  which  modern  research  has  since 
identified:  cinchona,  ipecacuanha,  mercury,  and  the 
iodides.  Contrast  with  this,  he  said,  the  resources  of 
modern  therapeutics,  with  its  range  of  antitoxins  and 
bacterial  products,  and  its  growing  list  of  new  synthetic 
compounds  discovered  as  the  result  of  deliberate  and 
organized  search  for  substances  which  shall  be  harmless 
to  the  infected  patient  in  doses  which  kill  or  prevent  the 
multiplication  of  the  infecting  organism.  A new  and 
exactly  chemical  basis  for  these  mysterious  phenomena 
of  immunity  is  even  now  being  built,  according  to  Sir 
Henry,  the  synthetic  production  of  artificial  specific  reme- 
dies for  infection  which  has,  in  the  course  of  some  twenty- 
five  years,  given  us  arsphenamine  and  other  organic  ar- 
senical compounds  such  as  tryparsamide;  various  deriva- 
tives of  antimony;  and  complex  organic  substances  re- 
lated to  the  dyestuffs  on  the  one  hand  or  to  natural 
alkaloids  on  the  other.  These  synthetic  substances  may 
be  properly  classed  with  the  antitoxins  and  other  anti- 
bacterial substances,  as  artificial  and  natural  agents  for 


120 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  7 


the  removal  from  the  body  of  harmful  invaders  front 
without. 

A second  principal  factor  in  this  change  in  therapeu-, 
tic  outlook  may  be  found  in  the  recognition  of  diseases 
due  to  the  lack  of  substances  normally  present  in  the! 
body.  Modern  therapeutics,  he  said,  can  show  no  tri- 
umphs  more  brilliant  than  those  which  have  followed  the 
discovery  of  methods  of  preparing  a number  of  glandu- 
lar products  in  a state  of  sufficient  purity  to  enable  them,' 
by  artificial  administration,  to  correct  an  abnormal  de- 
ficiency. 

It  would  be  possible,  he  said,  to  regard  this  remarkable; 
change  in  therapeutic  outlook  and  method  simply  as  one1 
phase  in  the  general  scientific  development  which  ha§ 
transformed  a whole  range  of  human  activities  in  a gen-\ 
eration.  He  felt  that  if  we  look  for  a particular  rather* 
than  a general  cause,  we  shall  find  it  in  the  rapidity  with 
which  chemical  knowledge  and  ideas  have,  in  this  same 
period  permeated  the  whole  of  medical  and  biological' 
science. 

The  newer  developments  have  but  little  relation  to  the 
art  of  the  individual  pharmacist  whom  our  fathers  knew, 
said  the  speaker,  but  we  must  resign  ourselves,  as  in  other, 
spheres  of  human  activity,  to  the  loss  of  the  individual' 
art  in  exchange  for  scientifically  organized  production. 
In  fact,  he  continued,  in  order  to  meet  these  novel,  vari- 
ous, and  expanding  demands  of  modern  therapeutics,, 
pharmacy  has  to  become  one  of  the  most  highly  organized 
departments  of  scientific  manufacture,  covering  an  ex- 
traordinary range  of  expert  knowledge  and  equipment. 
He  cited,  in  addition,  a much  more  fundamental  require- 
ment, calling  particular  attention  to  the  need  for  re- 
search undertaken  in  the  spirit  of  free  inquiry,  often  with 
no  immediate  practical  aim  or  any  probable  result  other 
than  the  increase  of  fundamental  knowledge. 

The  speaker  paid  tribute  to  Eli  Lilly  and  Company  for 
their  high  rank  among  industrial  organizations  which  have 
supported  scientific  research  for  its  own  sake  and  because 
they  have  known  how  to  value  the  spirit  which  is  en- 
gendered when  scientific  workers  are  given  a wide  free- 
dom. 

PROCEEDINGS*  OF  SOCIETIES 


The  Southeast  Arkansas  Medical  Society  elect- 
ed the  following  officers  at  the  October  meet- 
ing held  in  Lake  Village:  President,  H.  T.  Smith, 
McGehee;  Vice-President,  J.  S.  Wilson,  Monti- 
cello;  and  Secretary-Treasurer,  M.  C.  Crandall, 
Wil  mot.  The  meeting  was  addressed  by  Drs. 
E.  H.  White,  Little  Rock,  and  C.  A.  Rosenbaum, 
McGehee. 


The  Tri-County  Clinical  Society  met  at  Arka- 
delphia  October  25th  for  the  following  program: 
"The  Injection  Treatment  of  Rectal  Prolapse,"  T. 
N.  Black;  "The  Importance  of  Changes  in  the 
Visual  Field,"  O.  H.  King;  and  "The  Significance 
of  Cardiac  Murmurs,"  A.  G.  Sullivan,  all  speak- 
ers from  Hot  Springs  National  Park. 

C.  K.  Townsend,  Secretary. 


Insane,"  F.  G.  Engler,  Mountainburg;  "ERA  Med- 
ical Relief  Plan,"  S.  J.  Wolfermann,  Fort  Smith. 

S.  D.  Kirkland,  Secretary. 

The  First  Councilor  District  Medical  Society 
met  at  Jonesboro  October  24th  and  elected  the 
following  officers:  President,  Ira  Ellis,  Monette, 
and  Vice-President,  R.  H.  Willett,  Jonesboro.  The 
following  program  was  presented: 

"Obstetrics  at  the  Bedside,"  H.  R.  McCar- 
roll,  Walnut  Ridge. 

"The  Variability  in  Symptoms  and  Treatment 
of  Encephalitis,"  R.  C.  Bunting,  Memphis. 

"The  Dysenteries  with  Reference  to  Sodium 
Thiocyanate  in  Their  Treatment  in  1933  and 
1934,"  L.  D.  Massey,  Osceola. 

"Infections  of  the  Hand,"  Geo.  Lewis,  Little 
Rock. 

"Symptoms  and  Diagnosis  of  Heart  Disease," 
S.  C.  Fulmer,  Little  Rock. 

"Diphtheria,"  J.  E.  McGuire,  Piggott. 

The  next  meeting  wil!  be  held  at  Monette. 

R.  M.  Sloan,  Secretary. 

The  Benton  County  Medical  Society  met  at 
Siloam  Springs  November  8th,  the  guests  of  Dr. 
and  Mrs.  L.  L.  Scott  for  dinn,er.  Speakers  were: 
Drs.  L.  M.  Henry,  "The  Differential  Diagnosis  of 
Common  Ear  Conditions,"  and  F.  H.  Krock,  "Car- 
cinoma of  the  Cervix." 


The  following  program  was  presented  at  the 
meeting  of  the  Sebastian  County  Medical  So- 
ciety held  November  13th:  Symposium  on  Duo- 
denal Ulcer — Medical  Aspect,  S.  J.  Wolfermann; 
Surgical  Aspect,  F.  H.  Krock,  and  Roentgenologi- 
cal Aspect,  W.  R.  Brooksher. 

J.  W.  Amis,  Secretary. 

The  Ouachita  County  Medical  Society  was  ad- 
dressed at  its  meeting  November  7th  by  Drs.  D. 
E.  White,  F.  O.  Mahony,  A.  D.  Cathey  and  G.  D. 
Murphy,  all  of  El  Dorado. 

® 

COMING  MEDICAL  MEETINGS 


Radiological  Society  of  North  America,  Memphis,  De- 
cember 3rd  to  7th. 

Ninth  Councilor  District  Medical  Society,  Harrison, 
December  4th. 

Eighth  Councilor  District  Medical  Society,  Little  Rock. 
December  5th. 

Medical  Association  of  Missouri  Pacific  Railroad,  New 
Orleans,  January  25,  1935. 

Dallas  Southern  Clinical  Society,  Dallas,  March  18th 
to  25th,  1935. 

Arkansas  Medical  Society,  Fort  Smith,  April  15,  16, 
17,  1935. 


Crawford  County  Medical  Society  met  Octo- 
ber 23rd  for  the  following  program:  "Sane  or 


December,  1934] 


ARKANSAS  MEDICAL  SOCIETY 


121 


PERSONALS  AND  NEWS  ITEMS 


Dr.  and  Mrs.  F.  J.  Scully,  Hot  Springs  National 
Park,  took  a vacation  cruise  to  Central  America 
and  Cuba  in  October. 


"Oxygenated  Blood  in  Transfusion"  by  S.  F. 
Hoge,  Little  Rock,  appears  in  the  October  issue 
of  "The  Mississippi  Doctor." 


The  1934  Christmas  Seal  of  The  National  Tu- 
berculosis Association,  reproduced  elsewhere  in 
this  issue  of  "The  Journal,"  commemorates  the 
fiftieth  anniversary  of  the  building  of  the  cottage 
that  became  the  nucleus  of  Trudeau  Sanato- 
rium, Saranac  Lake,  N.  Y.  Among  the  county 
chairmen  for  the  1934  Seal  sale  in  Arkansas  are: 
B.  H.  Hawkins,  Polk  County,  Mena,  and  S.  C. 
Fulmer,  Pulaski  County,  Little  Rock. 


M.  F.  Lautman,  Hot  Springs  National  Park, 
has  recently  been  elected  a member  of  The 
American  Committee  for  the  Study  and  Con- 
trol of  Rheumatic  Diseases. 


F.  W.  Carruthers  and  H.  W.  Hundling,  Little 
Rock,  addressed  the  October  meeting  of  the 
Lonoke  County  Medical  Society. 


The  following  were  elected  officers  of  the  Tri- 
State  Medical  Society  in  Shreveport:  L.  J.  Kos- 
minsky,  Texarkana,  President;  T.  H.  Jones,  Mag- 
nolia, Vice-President;  and  G.  E.  Cannon,  Hope, 
Councilor.  The  next  meeting  of  the  Society  will 
be  held  in  Texarkana. 


Drs.  A.  J.  Hamilton  and  W.  G.  Hancock, 
Rison,  have  been  elected  president  and  secre- 
tary respectively  of  the  Cleveland  County  Medi- 
cal Society. 

J.  S.  Wilson,  Monticello,  and  S.  W.  Douglas, 
Eudora,  addressed  the  Lincoln  County  Medical 
Society  October  5th. 

With  the  death  of  Dr.  A.  G.  Harrison,  of 
Searcy,  the  firm  name  of  Drs.  Harrison  and 
Hawkins  will  be  dropped,  Martin  C.  Hawkins, 
Jr.,  continuing  in  the  practice  of  general  sur- 
gery. 

"Brucelliasis:  General  Considerations,"  by  W. 
B.  Grayson  and  Gordon  Hastings,  Little  Rock, 
appears  in  the  November  "Southern  Medical 
Journal." 


Fellowships  were  conferred  upon  Martin  C. 
Hawkins,  Jr.,  Searcy,  Earle  A.  Hunt,  Clarksville, 
and  Clyde  McNeil,  Rogers,  at  the  recent  convo- 
cation of  the  American  College  of  Surgeons  in 
Boston.  Joe  F.  Shuffield,  Little  Rock,  and  J.  K. 
Smith,  Texarkana,  attended  the  Congress  as  Fel- 
lows. 


S.  C.  Fulmer  and  H.  W.  Hundling,  Little  Rock, 
addressed  the  Miller  County  Medical  Society 
October  18th  on  "Symptoms  and  Diagnosis  of 
Heart  Disease"  and  "The  Treatment  of  Toxic 
Goiter,"  respectively. 


F.  H.  Krock,  Fort  Smith,  was  Guest  Chairman 
at  the  Stomach  Surgery  Section  of  the  Oklahoma 
City  Clinical  Conference  October  29th. 


J.  A.  Thompson,  Dermott,  has  been  elected 
President  of  the  South  Arkansas  Singing  Con- 
vention. 


Alfred  Hathcock,  Fayetteville,  addressed  the 
pre-medical  students  of  the  University  of  Arkan- 
sas on  October  23rd. 


In  attendance  at  the  Oklahoma  City  Clinical 
meeting  October  29-November  1st  were:  W.  M. 
Blackshare,  Hot  Springs  National  Park;  C.  A. 
Churchill,  Batesville;  H.  C.  Dorsey  and  F.  H. 
Krock,  Fort  Smith;  F.  C.  Maguire,  Augusta;  E.  C. 
Moulton  and  S.  J.  Wolfermann,  Fort  Smith. 


"Obstetrical  Difficulties"  by  S.  B.  Hinkle,  Little 
Rock,  appears  in  the  October  "Tri-State  Medical 
Journal." 


H.  Fay  H.  Jones,  Little  Rock,  was  selected 
President  of  the  Southwestern  Branch  of  the 
American  Urological  Association  at  the  meeting 
in  Saint  Louis  in  October.  This  Society  is  compos- 
ed of  urologists  from  the  states  of  Arkansas,  Col- 
orado, Kansas,  Missouri,  Nebraska,  Oklahoma  and 
Texas. 


Among  those  elected  November  6th  are: 
County  Judge,  Woodruff  County,  R.  L.  Fraser, 
McCrory;  Senator,  27th  District,  H.  B.  Hardy, 
Greenbrier;  Representative,  Howard  County,  W. 
H.  Toland,  Nashville,  and  Johnson  County,  G.  L. 
Hardgrave,  Clarksville. 

Dr.  M.  M.  Blakely,  Benton,  suffered  the  loss  of 
his  left  hand  as  the  result  of  a dynamite  explo- 
sion while  working  on  his  farm  November  12th. 


122 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  7 


Byron  L.  Robinson  and  W.  C.  Langston,  Little 
Rock,  presented  a scientific  exhibit,  "Castration 
atrophy  and  theelin:  Effect  of  theelin  on  uferi  of 
castrates,"  at  the  recent  meeting  of  the  Southern 
Medical  Association. 


B.  A.  Rhinehart,  Little  Rock,  will  present  "In- 
creased Irritability  of  the  Gastro-intestinal  Tract: 
A Discussion  of  Disturbed  Physiology,"  at  the 
meeting  of  the  Radiological  Society  of  North 
America  in  Memphis,  December  3rd. 


OBITUARY 


EDWARD  WALKER  BLACKBURN,  aged  59, 
died  suddenly  at  his  home  in  Ozark  on  October 
31st,  as  the  result  of  a heart  attack.  Dr.  Black- 
burn had  been  in  ill  health  for  some  time  but  his 
condition  had  not  been  considered  serious,  and 
on  the  evening  prior  to  his  death  appeared  to 
be  as  well  as  usual.  He  was  born  at  Ozark, 
February  18,  1875,  and  was  the  son  of  Dr.  Ed- 
ward Blackburn,  a pioneer  Arkansas  physician. 
He  was  a graduate  of  Cumberland  University 
and  of  the  Medical  Department  of  Vanderbilt 
University  in  1900.  He  had  served  as  deacon  of 
the  First  Presbyterian  Church  of  Ozark  for  35 
years  and  as  a teacher  of  the  men's  class  for 
many  years.  For  the  past  15  years  he  had  been 
a member  of  the  board  of  trustees  of  the  Col- 
lege of  the  Ozarks.  He  is  survived  by  his  wife. 


AUXILIARY  NEWS 


MRS.  D.  W.  GOLDSTEIN 
Publicity  Secretary 

616  North  Greenwood  Ave.,  Fort  Smith 

The  Obstetrical  Pack  Committee  of  the  Women's 
Auxiliary  of  the  Pulaski  County  Medical  Society  met 
Wednesday,  October  1 0th , at  the  home  of  Mrs.  D.  M. 
Switzer.  Attending  were:  Mrs.  Anderson  Watkins,  com- 
mittee chairman;  Mrs.  C.  E.  Oates,  Mrs.  J.  B.  Crawford, 
Mrs.  W.  E.  Gray,  Jr.,  Mrs.  B.  A.  Bennett,  Mrs.  F.  E. 
Hurrle,  Mrs.  C.  C.  Reed,  and  Mrs.  W.  H.  Miller.  Re- 
freshments were  served  at  the  close  of  the  meeting. 

The  Auxiliary  of  the  Tri-County  Clinical  Society  met 
October  25th  in  Arkadelphia  at  the  home  of  Mrs.  Charles 
K.  Townsend. 

Following  dinner  served  to  twelve  members,  an  in- 
teresting program  was  given.  Dr.  Smith,  director  of  the 
Clark  County  Health  Unit,  was  present  and  gave  an 
instructive  talk  on  "Milk  and  Milk  Products."  An  artist's 
program  presented  by  Misses  Elaine  Broughton  and  Linda 
Webb  of  Arkadelphia  concluded  the  program. 


MEDICAL  AUXILIARY  LUNCHEON 

Thirty-five  members  of  the  Woman's  Auxiliary  to  the 
Pulaski  County  Medical  Society  attended  the  dutch  treat 
luncheon  Wednesday,  October  17th,  at  the  Peacock  tea- 
room, opening  the  season's  activities.  Mrs.  William  Hib- 
bitts  of  Texarkana,  state  president,  was  guest  speaker. 
Mrs.  J.  B.  Crawford,  president  of  the  auxiliary,  presided. 


Mrs.  B.  A.  Rhinehart,  Little  Rock,  addressed  the  mem- 
bers and  guests  of  the  Caddo  Parish  Auxiliary  (Shreve- 
port) at  a luncheon  given  in  honor  of  the  wives  of  physi- 
cians in  attendance  at  the  Tri-State  Medical  Society 
meeting  October  17th. 


Mrs.  L.  S.  Lippincott  of  Mississippi  has  written  the 
following  plea  to  auxiliary  women  of  her  state  and  your 
publicity  chairman  is  asking  each  auxiliary  in  Arkansas 
to  please  use  this  suggestion: 

"Co-operation  is  the  key  word  of  success.  Your  pub- 
licity chairman  is  helpless  without  the  co-operation  of 
every  auxiliary  in  the  state.  You  are  not  co-operating 
when  you  fail  to  send  in  news  and  clippings  each  month. 

Help  in  every  way  you  can  with  the  key  word,  Co- 
operation." 

The  Bowie-Miller  County  Medical  Auxiliary  met  with 
Mrs.  H.  E.  Longino  October  26  at  3 o'clock. 

Mrs.  Preston  Hunt,  president  of  the  Texas  Auxiliary, 
and  Mrs.  William  Hibbitts,  president  of  the  Arkansas 
Auxiliary,  gave  reports  from  the  state  board  meetings 
of  Texas  and  Arkansas.  Mrs.  Hunt  told  of  organizing  an 
auxiliary  in  Tyler,  Texas,  while  Mrs.  Hibbitts  has  organized 
one  at  Walnut  Ridge,  Arkansas.  Mrs.  P.  H.  Phillips  of 
Ashdown  led  the  meeting.  The  subject  was  "Biographies 
of  Outstanding  Physicians." 

<$> 

A.  M.  A.  BULLETIN 


On  October  12,  1934,  1 forwarded  a bulletin  to  the 
secretaries  of  all  constituent  state  and  territorial  medical 
associations.  The  first  part  of  that  bulletin,  pertaining 
to  the  Committee  on  Economic  Security,  was  marked 
"Confidential"  for  the  reason  that  at  that  time  we  en- 
tertained some  hope  that  the  organized  medical  pro- 
fession would  be  asked  to  be  officially  represented  on 
the  Medical  Advisory  Committee  which  is  in  process 
of  organization  by  the  Executive  Director  of  the  Com- 
mittee on  Economic  Security.  We  have  now  received 
official  information  from  Prof.  Edwin  E.  Witte,  Executive 
Director  of  the  Committee  on  Economic  Security,  that 
in  connection  with  the  organization  of  the  Medical  Ad- 
visory Committee  selections  have  been  made  on  an  in- 
dividual basis  without  asking  for  nominations  from  any 
organization. 

In  a letter  received  from  Professor  Witte  under  date 
of  October  13,  written  in  reply  to  a letter  from  the  Sec- 
retary of  the  American  Medical  Association,  the  follow- 
ing information  is  submitted: 

1.  The  Director  of  the  Bureau  of  Medical  Economics 
of  the  American  Medical  Association  will  be  invited  to 
go  to  Washington  to  discuss  "the  economic  aspects  of 
the  problems  of  medical  care  of  people  in  very  low  in- 
come groups." 

2.  The  Medical  Advisory  Committee  now  being  or- 
ganized will  be  composed  of  physicians  selected  on  an 
individual  basis.  At  the  time  Professor  Witte's  letter 


December,  1934] 


ARKANSAS  MEDICAL  SOCIETY 


123 


was  written,  not  all  of  those  who  had  been  invited  to 
serve  on  the  Medical  Advisory  Committee  had  replied. 

3.  The  names  of  the  prospective  members  of  the 
Medical  Advisory  Committee  would  not  be  disclosed. 
(In  a letter  received  from  Professor  Witte  under  date 
of  October  22,  it  is  stated  that  he  hopes  "to  announce 
the  Medical  Advisory  Committee  in  the  very  near  fu- 
ture," and  that  he  is  "planning  committees  of  consult- 
ants in  the  fields  of  dentistry,  hospital  management  and 
public  health.") 

4.  The  Committee  on  Economic  Security  will  be  glad 
to  have  suggestions  from  the  American  Medical  Asso- 
ciation or  its  officers  on  any  phase  of  its  work  at  any 
time.  (It  is  presumed  that  the  Committee  will  likewise 
welcome  suggestions  from  state  medical  associations  or 
from  the  officers  of  those  organizations.) 

5.  Professor  Witte  will  make  an  effort  to  visit  the 
offices  of  the  American  Medical  Association  "shortly  be- 
fore the  New  Year." 

6.  The  assurance  of  co-operation  extended  by  the 
Board  of  Trustees  and  officers  of  the  American  Medical 
Association  are  sincerely  appreciated. 

Accompanying  Professor  Witte's  letter  of  October  22 
is  a mimeographed  copy  of  an  "Information  Primer"  of 
the  Committee  on  Economic  Security.  This  is  not  dated 
but  was  evidently  released  before  October  13,  since  a 
statement  based  on  this  release  appeared  in  the  New 
York  Times  for  that  date.  In  the  "Primer"  it  is  stated 
that  the  report  of  the  Committee  on  Economic  Security 
to  the  President  is  due  to  be  made  on  December  I,  1934, 
and  will  not  be  made  public  until  released  by  the  Presi- 
dent. It  is  also  stated  -that  among  the  studies  initiated 
by  the  Committee  on  Economic  Security  is  one  on  "Pro- 
visions for  Meeting  the  Economic  Risks  of  Illness,"  and 
that  Mr.  Edgar  Sydenstricker  and  Dr.  I.  S.  Falk,  both  of 
whom  are  in  the  employ  of  the  Milbank  Fund,  are  in 
charge  of  this  particular  study.  Professor  Witte  informs 
me  that  neither  Mr.  Sydenstricker  nor  Doctor  Falk  will 
be  a member  of  the  Medical  Advisory  Committee  of 
the  Committee  on  Economic  Security. 

Dr.  Walter  L.  Bierring,  President  of  the  American 
Medical  Association,  has  been  invited  to  serve  as  a 
member  of  the  Medical  Advisory  Committee  and  has  ac- 
cepted. The  invitation  was  addressed  to  Doctor  Bierring 
as  an  individual  and  not  as  President  of  the  American 
Medical  Association.  I have  heard  that  the  President  of 
the  American  College  of  Surgeons  and  the  President  of 
the  American  College  of  Physicians  have  received  simi- 
lar invitations,  though  this  information  did  not  come  from 
official  sources  in  Washington. 

It  seems  reasonable  to  assume  that  the  President  of 
the  United  States,  after  the  report  of  the  Committee  on 
Economic  Security  has  been  submitted  to  him  on  or 
about  December  I,  will  decide  whether  or  not  plans  for 
providing  some  system  of  sickness  insurance  will  be  in- 
cluded in  the  program  of  social  insurance  which  it  is 
reported  he  will  submit  to  Congress. 

A member  of  the  last  Congress,  who  is  seeking  re- 
election  in  the  November  elections,  has  addressed  letters 
to  physicians  in  Illinois  in  which  it  is  stated  that  he  has 
been  informed  that  a bill  providing  for  sickness  insurance 
will  be  introduced  at  the  next  session  of  Congress.  I am 
informed  that  similar  statements  have  been  made  by 
other  Congressmen.  The  I llinois  candidate  for  Congress 
has  asked  physicians  to  give  him  the  benefit  of  their 
views  with  respect  to  sickness  insurance.  Printed  mate- 


rial dealing  with  this  subject  has  been  forwarded  to  him 
and  to  other  candidates  for  election  as  Congressmen. 

A letter  received  at  the  offices  of  the  American  Med- 
ical Association  from  the  President  of  the  National  Con- 
gress of  Parents  and  Teachers  states  that  a letter  from 
the  Twentieth  Century  Fund  was  before  the  Board  of  the 
National  Congress  of  Parents  and  Teachers  asking  that 
body  to  "endorse  Pres.  Roosevelt's  plan  of  Health  In- 
surance," and  was  rejected  by  the  Board. 

In  the  "Information  Primer"  released  by  the  Committee 
on  Economic  Security,  the  following  statement  is  made: 

"Following  the  approach  outlined  by  the  President, 
the  Committee  is  trying  to  draw  up  a comprehensive 
program  which  will  give  protection  to  the  individual  from 
all  the  vicissitudes  and  hazards  of  modern  life — unem- 
ployment, accident,  sickness,  invalidity,  old  age,  and: 
premature  death. 

"It  is,  of  course,  not  contemplated  that  this  program 
shall  go  into  effect  in  its  entirety  immediately,  but  it  is. 
planned  to  give  Congress  and  the  country  a 'look  ahead' 
as  well  as  some  recommendation  for  immediate  action, 
to  the  end  that  there  may  be  developed,  from  the  out- 
set, a unified  plan  for  economic  security." 

It  seems  quite  probable  that  no  hearings  on  sickness, 
insurance  will  be  held  under  the  auspices  of  the  Com- 
mittee on  Economic  Security.  It  is,  of  course,  presumed 
that  if  any  bill  providing  for  sickness  insurance  is  sub- 
mitted to  Congress,  official  hearings  will  be  held  by  the 
committee  to  which  such  bill  will  be  referred. 

Since  the  American  Medical  Association  and  many  of 
its  constituent  medical  associations  have  gone  on  record 
in  opposition  to  sickness  insurance,  it  is  extremely  de- 
sirable that  the  views  of  the  organized  medical  profes- 
sion should  be  made  known  to  members  of  Congress  and: 
to  candidates  for  election  as  members  of  that  body.  It 
is  suggested,  therefore,  that  the  officers  of  constituent 
state  medical  association  and  of  component  county- 
medical  societies  and  the  members  of  the  legislative 
committees  of  these  bodies  immediately  develop  plans 
for  acquainting  members  of  Congress  and  candidates 
for  election  to  that  body  with  the  expressed  official 
views  of  the  organized  profession  in  the  United  States 
pertaining  to  sickness  insurance.  Most  of  the  members 
of  Congress  and  all  the  candidates  for  election  are  now 
at  home. 

In  the  meantime,  an  earnest  effort  will  be  made  fur- 
ther to  inform  the  Executive  Director  of  the  Committee 
on  Economic  Security  and  the  members  of  that  Com- 
mittee concerning  the  official  attitude  of  the  American 
Medical  Association  with  respect  to  sickness  insurance 
and  the  basis  of  the  Association's  opposition  to  any 
plan  involving  governmental  control  of  medical  practice. 

Very  sincerely  yours, 

OLIN  WEST,  Secretary, 

American  Medical  Association. 
«> 

Application  blanks  are  now  available  for  space  in  the 
Scientific  Exhibit  at  the  Atlantic  City  Session  of  the 
American  Medical  Association,  June  10-14,  1935.  The 
Committee  on  Scientific  Exhibit  requires  that  all  appli- 
cants fill  out  the  regular  application  form  and  requests 
that  this  be  done  as  early  as  convenient.  Applications 
close  February  25,  1935. 

Persons  desiring  application  blanks  should  address  a 
request  to  the  Director,  Scientific  Exhibit,  American  Medi- 
cal Association,  535  North  Dearborn  Street,  Chicago, 
Illinois. 


124 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  7 


BOOK  REVIEWS 


Recent  Advances  In  Allergy.  By  Geo.  W.  Bray,  M.  B., 
Ch.  M.  (Sydney),  M.  R.  C.  P.  (London).  Physician  in 
Charge  of  Children's  Department,  Prince  of  Wales  Hos- 
pital; Clinical  Assistant,  Asthma  Clinic,  Guy's  Hospital, 
etc.  Pp.  471  with  106  illustrations  and  4 colored  plates.  2nd 
edition.  Price  $5.00.  Philadelphia;  P.  Blakiston's  Sons 
and  Co.,  Inc.,  1934. 

This  book  is  all  that  its  title  indicates,  and  in  addition, 
each  important  division  is  preceeded  by  an  interesting 
and  instructive  history,  proving  that  Allergy  is  by  no 
means  a new  field. 

In  the  preface,  Dr.  Bray  states  with  pride  that  the  Eng- 
lish played  a most  important  part  in  the  pioneer  work 
in  allergy,  but  admits  that  priority  in  its  application  now 
rests  in  America. 

Though  giving  an  excellent  review  of  progress  to  date, 
with  no  pet  claims  or  theories  of  importance  slighted,  the 
author  does  not  hesitate  to  express  his  own  conclusions 
which  are  based  on  a wide  actual  experience.  His  work 
carries  the  conviction  of  an  unbiased  and  an  extremely 
well  balanced  estimation  of  allergy  as  an  important  field 
in  medicine. 

The  subject  is  logically  presented,  starting  with  funda- 
mental facts  and  theories  of  allergy,  with  a discussion  of 
the  physiology  and  pathology  involved.  The  chapter  on 
the  Nasal  Factor  in  Allergy,  especially  in  its  relation  to 
sinus  infection  and  asthma,  is  particularly  definite  and 
convincing.  He  shows  clearly  that  nasal  pathology  is 
often  due  to  allergy,  but  that  allergic  symptoms  are  not 
due  to  nasal  pathology.  The  extreme  variations  in  per-i 
centages  of  nasal  pathology  found  by  different  authors 
certainly  casts  doubt  on  the  soundness  of  our  accepted 
methods  of  diagnosing  nasal  and  sinus  pathology.  He 
also  pays  particular  attention  to  recurrent,  periodic  bron- 
chitis seen  so  commonly  in  children. 

Besides  respiratory  allergy,  major  divisions  are  devoted 
to  the  recognition,  diagnosis,  and  treatment  of:  Cuta- 
neous allergy  (flexural  pruritis,  eczema,  contact  derma- 
titis, urticaria,  purpura,  erythema  multiforme,  erythema 
nodosum,  and  dermatitis  herpetiformis);  Cerebral  mani- 
festations of  allergy;  Gastro-intestinal  symptoms;  Bac- 
terial allergy;  and  Physical  allergy.  Some  cardio-vascular 
and  joint  conditions  are  mentioned  as  possible  allergic 
reactions. 

A feature  of  the  book  which  makes  for  clarity  is  the 
frequent  summarization  of  important  discussions. 

—ALAN  G.  CAZORT. 


Summary  of  Pennsylvania's  Poor  Relief  Laws  Affecting 
Care  of  Indigent  Sick.  A Digest  of  Laws  and  Practices 
with  Supplements  Discussing  the  Pennsylvania  Plan  for' 
Emergency  Medical  Service  to  Those  on  Unemployment 
Relief  and  Pennsylvania's  Work  Relief  Compensation  Fund. 
Paper.  Pp.  100.  Harrisburg:  Medical  Society  of  the 
State  of  Pennsylvania,  1934. 

This  handy  volume  was  prepared  by  the  Medical  So- 
ciety of  the  State  of  Pennsylvania  for  distribution  to  per- 
sons interested  in  providing  minimum  adequate  medical 
relief  to  the  indigent.  The  methods  used,  the  amounts 
paid,  and  suggestions  for  improvement  are  furnished  by 
county  reports.  The  poor  laws  of  Pennsylvania  are  in- 
terpreted. Discussions  are  included  of  the  working  of 
the  Emergency  Relief  Administration's  services  and  of 
the  Compensation  Fund. 


Practical  Talks  on  Heart  Disease.  By  Geo.  L.  Carlisle, 
M.  D.,  Assoc.  Prof.  Clin.  Med.,  Baylor  University,  Dallas. 
Pp.  100.  Price  $2.00.  Springfield,  Illinois:  Charles  C. 
Thomas,  1934. 

In  this  volume  the  author  gets  away  from  the  time 
honored  and  awkward  classification  of  heart  disease,  such 
as  mitral  requrgitation,  mitral  stenosis,  aortic  insufficien- 
cy, etc.,  and  speaks  of  the  heart  as  a whole  under  varying 
pathological  conditions.  In  other  words  he  deals  suc- 
cin  tly  with  the  hypertensive  heart;  the  rheumatic  heart; 
the  arteriosclerotic  heart,  and  the  leutic  heart.  There  is 
no  attempt  made  to  give  the  anatomy,  physiology  or 
pathology  of  cardiac  disease,  but  rather  the  author  gives 

us  a picture  of  the  patient  himself  as  he  suffers  from 

these  various  heart  affections. 

The  language  used  in  the  book  is  so  direct,  terse  and 
clear  that  it  is  a relief  for  one  to  read  it.  Without  hav- 
ing to  wade  through  technical  discussions  and  complicated 
electrocardigrams,  basal  metabolisms,  etc.,  one  is  shown 
how  a rather  accurate  diagnosis  of  cardiac  disease  can 
be  made  from  a careful  history,  alert  observation,  and 
the  painstaking  iTte  of  simple  procedures  such  as  palpa- 
tion, percussion  and  anscultation. 

Treatment,  as  outlined  by  the  author,  is  to  be  com- 
mended for  its  simplicity.  Drugs  are  used  only  when 

indicated  and  the  multiplicity  of  cardiac  remedies  found 
in  our  present  materia  medica  is  eliminated.  If  the 
reader  gets  nothing  else  out  of  the  perusal  of  this  book 
than  the  idea  that  altogether  too  much  medication  is 
used  in  cardiac  disease,  then  it  is  a worthwhile  contribu- 
tion to  our  literature. 

This  little  book  gives  practical  advice  as  to  how  to 
handle  the  patient  with  tact  and  direct  him  toward 
leading  a more  comfortable  and  safer  life.  I feel  that 
in  view  of  our  present  day  frequent  cardiac  disasters 
that  it  is  worth  while  for  physicians  to  study  all  factors 
that  deal  with  heart  disease. 

While  the  author  does  not,  in  my  opinion,  give  enough 
space  to  angina  and  coronary  thrombosis,  at  the  same 
time  he  sums  up  practically  all  of  the  present  day  know- 
ledge of  these  conditions.  I feel  that  this  is  a read- 
able, handy  volume  for  the  general  practitioner. 

— S.  M.  GATES. 


Surgical  Clinics  of  North  America:  Issued  serially,  one 

number  every  month.  Volume  14,  Number  4.  Chicago 
Number — August,  1934.  288  pages  with  88  illustrations. 

Per  clinic  year  February,  1934,  to  December,  1934.  Paper, 
$12.00;  Cloth,  $16.00  net.  Philadelphia  and  London:  W. 
B.  Saunders  Company,  1934. 

This  issue  of  the  clinics  is  started  with  a symposium  on 
plastic  surgery,  interesting  even  to  those  physicians  who 
do  not  practice  this  specialty.  Koch,  in  dealing  with 
burns,  calls  attention  to  the  fact  that  "traction  or  fixa- 
tion to  prevent  scar  formation  will,  even  when  carefully 
applied,  fail  in  its  objective  and  may  even  be  detrimental." 
Active  full-range  movements  are  encouraged  and  re- 
warded. An  interesting  case  of  transplantation  of  the 
toes  to  the  fingers  for  cosmetic  reasons  is  reported.  A 
simple  multiple  state  operation  for  hypospadias  which 
does  not  require  cystotomy  is  described.  There  is  a dis- 
cussion of  whether  or  not  kidney  stones  may  be  dissolved 
based  upon  a case  in  which  there  was  roentgenological 
disappearance  of  the  shadows  after  the  patient  had  been 
placed  on  distilled  water.  This  issue  closes  with  another 
symposium,  peptic  ulcer,  in  which  the  thought  is  empha- 
sized that  this  condition  requires  the  team-work  of  all 


December,  1934] 


ARKANSAS  MEDICAL  SOCIETY 


125 


specialists  and  no  one  singly.  The  efficacy  of  medical 
or  surgical  treatment  should  be  checked,  and  can  be 
determined,  by  the  roentgen-ray.  However,  this  method 
will  not  permit  the  determination  of  the  activity  or  of  the 
healing  stage  as  presented  by  the  ulcer. 

I.  F.  JONES. 


Cataract:  Its  Etiology  and  Treatment.  By  Clyde  A. 
Clapp,  M.  D.,  F.  A.  C.  S.,  Associate  professor  Opthal- 
mology,  John  Hopkins  University:  Professor  of  Opthal- 
mology,  University  of  Maryland;  Visiting  Opthalmologist, 
Johns  Hopkins  Hospital  and  Wilmer  Institute;  Opthal- 
mologist, University  of  Maryland  Hospital.  Pp.  266.  92' 
illustrations.  Price  $4.00.  Philadelphia,  Lea  and  Febiger, 
1934. 

There  is  a vast  amount  of  material  in  this  small  vol- 
ume. In  short,  it  is  a synopsis  of  the  literature,  with 
many  comments  and  individual  expressions  of  opinion  by 


the  author.  The  illustrations  while  few  in  number  are 
adequate,  well  reproduced,  and  well  chosen  to  fit  the 
text. 

The  two  opening  chapters  by  Ida  C.  Mann  on  the 
embryology  and  comparative  anatomy  of  the  crystalline 
lens  are  not  too  technical  for  the  average  reader.  The 
balance  of  the  twenty-five  chapters  discuss  all  phases  of 
the  opthamologists'  dealing  with  the  crystalline  lens.  It 
is  noteworthy  that  the  chapters  on  treatment  favor  sim- 
plicity of  technique  in  operative  work.  The  information 
on  cataract  extraction  complicated  by  a preceding  tre- 
phine operation  is  rather  hastily  covered  but  it  is  com- 
mendable to  find  it  discussed. 

This  book  should  appeal  to  all  opthalmologists  wheth- 
er experienced  or  beginners,  and  to  the  research  worker 
and  writer  it  will  be  particularly  useful  because  of  a very 
complete  bibliography  totalling  six  hundred  and  sixty- 
six  references  to  the  literature. 

— E.  C.  Moulton. 


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THE  JOURNAL 

^ of  the  ARKANSAS  MEDICAL  SOCIETY  ^ 

PUBLISHED  MONTHLY  UNDER  DIRECTION  OF  THE  COUNCIL 
Vol.  XXXI  FORT  SMITH,  ARKANSAS,  JANUARY,  1935  No.  8 


CONSERVATIVE  v.  RADICAL 
SURGERY* 

ISAAC  G.  JONES,  M.  D. 

DeQueen 


It  has  often  been  stated  that  the  only  justifica- 
tion for  a medical  paper  is  that  it  must  present 
either  (I)  something  new  and  unknown  to  the 
profession,  such  as  a discovery,  a theory,  an 
observation  or  a deduction;  (2)  a new  slant  or  a 
new  interpretation  of  a well-known  fact  or  sub- 
ject; or  (3)  a repetition  for  emphasis  of  well- 
known  facts  that  are  really  important,  yet  tend 
to  be  forgotten  or  neglected.  I trust  that  this 
short  paper  will  fall  within  the  requirements  of 
either  the  second  or  third  of  the  above  requi- 
sites, for  it  probably  contains  nothing  new  or  un- 
known to  the  medical  profession. 

The  mere  mention  of  the  word  "radical"  en- 
genders in  the  average  human  mind  an  unfa- 
vorable, defensive  reaction,  whether  it  is  applied 
to  politics,  religion,  medical  treatment,  surgery 
or  any  other  subject  or  human  activity.  To  say 
of  any  man  "he  is  a radical,"  on  any  line  what- 
sover,  is  to  place  him  without  the  pale  of  trust 
and  confidence;  sets  him  apart  as  one  who  should 
be  watched  by  sane  people.  On  the  other  hand, 
it  seems  that  a vast  majority  of  people,  physi- 
cians and  surgeons  included,  pride  themselves  on 
being  conservative  in  all  their  views  and  actions. 
I hope  that  simply  because  I dare  discuss  both 
conservative  and  radical  surgery  that  I will  not 
be  too  severely  discredited  if  I seem  to  lean  to 
the  radical  side  on  certain  matters. 

Let  us  now  consider  what  the  term  "radical" 
means  when  applied  to  surgery.  The  usual  con- 
notation of  the  term  is  in  relation  to  the  amount 
of  tissue  sacrificed  at  the  time  of  operation.  For 
example:  extirpation  of  the  gall  bladder  would 
be  radical  when  compared  to  cholecystotomy; 
whereas,  cholecystotomy  would  be  radical  when 
compared  with  nonsurgical  drainage.  Hence, 
the  usual  meaning  and  use  of  the  term  becomes 

* Read  before  the  Fifty-ninth  annual  session  of  the 
Arkansas  Medical  Society,  held  in  Little  Rock  April  16-18, 
1934. 


relative.  Any  one  procedure  may  be  called  rad- 
ical only  when  compared  with  another  proce- 
dure that  is  less  radical  from  some  standpoint, 
hence,  more  conservative. 

How  well  I remember  the  first  surgeon  I ever 
saw  tie  the  base  of  an  appendix,  cut  it  off,  cau- 
terize the  stump  and  drop  it  back  in  the  belly. 

I had  been  taught,  and  meticulously  followed  up 
to  that  time,  invagination  technique.  At  the  time 
I saw  this,  I thought  it  was  the  most  radical  pro- 
cedure possible  and  was  surprised  to  learn  that 
this  surgeon's  mortality  and  morbidity  rates  were 
as  good  as,  if  not  better  than,  his  more  conserv- 
ative colleagues.  It  was  some  time  thereafter 
before  I could  get  up  enough  courage  to  do 
likewise.  We  are  prone,  then,  to  classify  as  rad- 
ical every  procedure  that  differs  in  any  minute 
detail  from  our  own  adopted,  cherished,  and 
therefore  conservative  modus  operandi.  Hence 
anything  that  we  ourselves,  do  not  do,  or  with 
which  we  are  not  familiar,  we  usually  classify  as 
radical. 

Any  surgical  procedure  is  usually  classified  as 
radical  when  the  patient  dies.  If  the  patient  lives, 
we  congratulate  ourselves  that  we  have  done  a 
wonderful  job  of  conservative  surgery.  If  the 
patient  dies,  we  blame  the  death  on  "low  resist- 
ance" of  the  patient  and  try  our  best  to  silence 
that  devilish  little  mental  "Jack-in-the-box"  that 
keeps  bobbing  up  asking  the  question:  "Were 
you  not  just  a little  too  radical  in  that  case?"  It 
matters  not  whether  too  much  or  too  little  tissue 
was  removed,  whether  you  used  your  own  pet 
technique  or  the  technique  of  some  other  sur- 
geon whom  you  consider  conservative,  that  op- 
eration was  a radical  operation  because  it  did 
not  conserve  life.  Again,  in  elective  operations 
for  the  relief  of  certain  symptoms  as  pain,  any 
operation  performed  which  does  not  relieve 
those  symptoms  would  be  a radical  operation; 
whereas,  any  operation  which  sacrificed  more 
tissue,  yet  relieved  the  distressing  symptoms, 
would  become  the  conservative  procedure. 

Any  so-called  conservative  operation  becomes 
a radical  operation  when  it  is  necessary  for  the 
patient  to  undergo  a second  operation  for  some 
condition  which  would  never  have  occurred  had 


128 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  <8 


the  first  operation  been  more  radical  from  some 
standpoint.  In  this  connection  it  occurs  to  me 
that  the  real  leaders  of  surgery  in  their  practice 
see  principally  two  classes  of  cases.  In  their  clinic 
work,  they  come  in  contact  only  with  charity 
cases  in  whom  the  question  of  finances  is  not  a 
matter  of  importance,  even  though  the  patient 
may  be  a breadwinner,  for  his  dependents  usually 
have  access  to  material  assistance  through  some 
relief  agency.  Neither  is  time  a matter  of  impor- 
tance, hence,  a second  operation  would  be  a 
relatively  small  matter.  The  other  class  of  cases 
with  which  the  leaders  of  surgery  usually  deal  is 
the  wealthy  class  to  whom  finances  are  likewise 
not  important,  neither  does  time  spent  in  the 
hospital  matter  very  much.  For  these  reasons, 
and  others,  the  real  leaders  of  surgery  probably 
do  not  appreciate,  to  the  fullest,  the  conditions 
faced  by  the  surgeons  handling  the  great  middle 
class,  the  vast  majority  of  their  cases. 

As  time  goes  by  and  more  and  more  surgery 
is  done,  it  is  quite  evident  that  the  basic  prin- 
ciples of  surgery,  surgical  judgment  and  tech- 
nique tend,  more  and  more,  to  change  and  im- 
prove in  the  surgery  of  every  part  of  the  human 
body,  the  female  pelvis  excepted.  In  this  region 
the  basic  principles  of  surgery  were  formulated 
during  the  early  days  of  surgery.  While  our  sur- 
gical technique  and  judgment  have  undoubtedly 
improved,  yet  we  go  on  from  year  to  year  con- 
forming to  certain  prerequisites  and  principles 
laid  down  in  those  early  days  of  surgery.  In  this 
special  field  of  surgery  there  has  always  been  in 
the  past  and  still  is,  a hard,  fast  and  unchange- 
able opinion  in  both  the  lay  and  professional 
minds  as  to  what  constitutes  a conservative  pro- 
cedure in  contradistinction  to  a radical  regimen. 
In  reading  the  writings  of  many  of  the  real 
leaders  in  surgery  who  have  stood  apart  and 
above  their  colleagues,  I find  they  do  not  hes- 
tate  to  sacrifice  normal,  healthy  tissue  when  the 
result  of  that  sacrifice  would  be,  in  any  way,  ad- 
vantageous to  the  patient  from  the  standpoint 
of  comfort,  utility  or  happiness,  especially  when 
it  involves  any  part  of  the  human  anatomy  other 
than  the  female  pelvis.  For  example,  no  surgeon 
would  amputate  a foot  at  the  ankle  joint  but 
would  sacrifice  several  inches  of  perfectly  healthy 
tissue  above  the  joint  so  that  a better  stump  for 
the  fitting  of  an  artificial  foot  could  be  obtained. 
In  doing  this  we  are.  radical  so  far  as  tissue  is 
concerned,  but  we  are  conservative  from  an 
economic,  utilitarian  and  cosmetic  standpoint. 
Yet,  the  same  leaders  when  discussing  surgery 
of  the  female  pelvis  all  march  proudly  up  to  the 


so-called  conservative  line  and  there  they  stand 
flat-footed,  refusing  to  budge  one  millimeter  in 
the  interest  of  comfort,  utility,  future  happiness 
or  peace  of  mind  of  their  patients. 

I am  really  at  a loss  for  an  explanation  of  this 
evident  inconsistency  unless,  perchance,  it  is  be- 
cause this  segment  of  the  human  body  is  the  one 
and  only  portion  thereof  whose  function  has  in 
any  way  been  associated  with  the  question  of 
morality.  When  the  realm  of  morality  is  entered, 
change  and  progress  become  slow.  Perhaps  the 
"Fathers  of  Medicine"  were  strongly  influenced 
by  the  "Fathers  of  the  Church."  Theology  quite 
early,  in  so-called  civilized  man's  history  assumed 
absolute  control  of  all  human  relational  and  prop- 
agational  questions.  I often  wonder  just  what 
the  status  of  pelvic  surgery  would  be  today  if 
in  the  past,  and  at  present,  purely  scientific  and 
biologic  principles  guided  both  the  head  and  the 
hand  of  the  gynecologist. 

Certain  quotations  from  surgical  literature 
written  by  recognized  surgical  leaders  are  inter- 
esting in  this  connection.  Howard  Kelly  in  his 
wonderful  work  "Operative  Gynecology"  makes 
this  statement:  "The  reason  for  conservatism  (in 
pelvic  surgery)  is  that  it  is  the  general  attitude 
of  all  true  surgery  . . . conservatism  is  the 
highest  aim  in  surgery."  In  my  opinion  this  state- 
ment is  absolutely  true  if  properly  construed. 
KeHy  does  not  state  specifically  whether  he 
means  conservation  of  tissue,  conservation  of 
future  comfort,  peace  of  mind,  economic  status, 
or  of  future  happiness.  If  he  means  conservation 
of  tissue  only,  which  I conclude  from  reading  his 
text,  I cannot  agree  with  him. 

Again,  the  same  author  says:  "The  pelvic 

organs  are  indelibly  associated  in  a woman's 
mi  nd  with  those  fundamental  differences  be- 
tween the  sexes  which  impress  upon  the  female 
organism  all  that  is  distinctive  and  peculiar  in 
her  attitude  toward  the  world  at  large;  and,  with 
the  healthy  performance  in  her  functions  in  the 
recurring  monthly  fluxes,  ovulation  and  the  pos- 
sibility of  conception,  lie,  though  the  woman  may 
be  unconscious  of  it,  some  of  the  deepest  well- 
springs  of  her  happiness." 

In  this  connection  I have  often  wondered  if  any 
woman  could  enjoy  her  "wellsprings  of  happi- 
ness" when  the  family  income  is  barely  sufficient 
to  feed,  clothe  and  educate  one,  two,  or  three 
children  when  there  are  six,  eight,  or  ten  chil- 
dren, or  the  prospects  thereof,  who  must  be 
cared  for  on  that  same  income.  I can  truthfully 
say  that  I have  yet  to  meet  the  woman  with  as 
many  as  three  children  in  whom  the  "possibility 


January,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


129 


of  conception"  was  still  a "wellspring  of  happi- 
1 1 

ness. 

In  summing  up  this  matter  Kelly  says:  "Finally, 
the  patient  has  an  inalienable  right  to  decide  in 
all  cases  that  her  pelvic  organs  shall  not  be  sac- 
rificed under  any  possible  complication  of  con- 
ditions which  may  exist,  and  the  conscientious 
surgeon  will  always  be  inclined  to  abet  her  in  her 
willingness  to  take  some  risks  in  order  to  preserve 
the  functions  of  nature."  If  this  be  true,  why 
then  would  not  the  conscientious  surgeon  like- 
wise abet  a woman  in  her  desire  to  better  fulfill 
her  responsibilities  to  an  already  existent  family 
which  her  judgment  tells  her  is  large  enough. 
Here  I am  reminded  of  a recent  case  which  came 
to  my  office  during  the  writing  of  this  paper. 
This  woman  is  twenty-six  years  old,  rather  frail 
and  delicate  but  very  intelligent,  the  mother  of 
two  children,  six  and  two  years  of  age.  One 
year  ago  she  was  operated  by  a prominent  Ark- 
ansas surgeon,  who,  if  I am  not  mistaken,  is  in 
this  room  at  this  time.  This  woman  sta'ted  to  me 
that  she  requested  of  this  surgeon  that  he  ope- 
rate in  such  a way  that  she  would  be  assured  of 
no  more  additions  to  her  family,  feeling  that  two 
children  were  all  to  whom  she  could  do  justice 
under  her  economic  circumstances.  She  further 
informed  me  that  this  surgeon  bluntly  told  her 
that  he  would  never  be  guilty  of  doing  such  sur- 
gery as  it  was  against  the  most  sacred  tenets  of 
the  profession.  At  the  present  time  this  poor 
woman  is  living  in  mortal  dread  of  another  preg- 
nancy. She  consulted  me  for  contraceptive  infor- 
mation, which  we  all  know  is,  at  best,  not  one 
hundred  per  cent  positive. 

Even  in  as  late  and  as  splendid  a work  as  Dean 
Lewis'  work  on  surgery,  in  the  chapter  written  by 
Faulkner  is  found  this  statement:  "Pelvic  surgery 
should  always  aim  to  preserve  the  reproductive 
and  menstrual  functions."  By  the  use  of  the  word 
"always"  is  maintained  the  inflexible  attitude 
which  is  evident  throughout  all  medical  literature 
on  pelvic  surgery. 

In  Crossen's  "Operative  Gynecology,"  which 
is,  in  most  matters,  my  own  personal  gospel,  the 
first  and  foremost  reason  which  he  gives  for  con- 
servative pelvic  surgery  is:  "Preservation  of  the 
possibility  of  pregnancy."  He  further  states: 
"Another  point,  sometimes  overlooked,  is  that 
even  though  no  pregnancy  results  from  these 
efforts  at  conservatism,  the  simple  fact  that  the 
patient  may  become  pregnant,  that  pregnancy  is 
still  possible,  conduces  much  to  her  peace  of 
mind."  I am  somewhat  at  a loss  to  understand 
why  so  astute  a mind  as  Crossen's  fails  to  dif- 


ferentiate between  nulliparous  and  multiparous 
peace  of  mind.  According  to  this  view  the  per- 
sonal right  of  determination  on  the  part  of  the 
woman  is  refused;  yet  her  personal  right  of 
determination  is  preached  in  case  she  is  willing 
to  take  added  risks  on  the  opposite  side.  Which 
all  reminds  me  that  consistency  is  a jewel,  rare 
and  seldom  seen. 

Always  thus,  I find  the  literature  which  it  has 
been  my  privilege  to  read  during  the  preparation 
of  this  paper.  I fully  realize  the  seemingly  radical 
tendency  of  my  position  and  the  fact  that  oft- 
times,  "fools  rush  in  where  angels  fear  to  tread." 
However,  I am  consoled  somewhat  by  the  knowl- 
edge that  some  times  it  is  the  crank  who  shows 
us  the  way.  As  has  been  stated  before,  when 
morality  enters,  progress  is  slow.  For  your 
thoughtful  consideration  I offer  the  following 
which,  to  a certain  extent,  may  be  said  to  ex- 
press certain  conclusions  to  which  I have  come. 

1.  The  terms  "radical"  and  "conservative" 
when  applied  to  surgery  are  relative  and  may 
apply  to  the  amount  of  tissue  removed,  present 
or  past  surgical  customs,  recognized  surgical 
technique,,  or  final  results  of  operation  when  re- 
sults are  considered  from  the  standpoint  of 
function,  relief  of  symptoms  or  personal  happi- 
ness. 

2.  Because  of  the  so-called  moral  and  social 
connections,  pelvic  surgery  has  not  received  the 
purely  scientific  and  truly  biologic  consideration 
which  it  deserves. 

3.  Any  sane  woman  has  the  same  inalienable 
right  to  elect  to  sacrifice  an  organ  or  function 
as  she  has  to  retain  the  same  and  the  truly  con- 
servative surgeon  will  accede  to  her  wishes,  all 
else  being  equal  from  the  standpoint  of  the  in- 
volved risk  to  her  life. 

4.  Most  women  of  today  are  intelligent  and 
therefore  capable  of  passing  upon  what  is  best 
for  themselves  from  the  standpoint  of  their  own 
economic  situation. 

5.  Conservative  pelvic  surgery  of  the  future 
will  consider  more  than  the  mere  sacrifice  of 
tissue.  To  be  truly  conservative  it  must  consider 
also  economic  status  and  feminine  peace  of 
mind. 

DISCUSSION 

F.  H.  KROCK,  Fort  Smith:  It  is  rather  difficult  to 

discuss  a philosophical  essay  such  as  the  one  we  have 
ju st  heard,  but  I think  all  of  us  will  have  to  admit  that 
Dr.  Jones  has  raised  a number  of  excellent  points,  whether 
we  agree  with  him  or  not.  I think  that  the  conservative 
attitude  of  the  surgeon  towards  sterilization  today  prob- 
ably results,  in  a large  part,  from  the  fact  that  we  do  a 


130 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  8 


large  percentage  of  our  work  in  hospitals  under  sectarian 
control  and  where  rigid  and  irrevocable  rules  and  regu- 
lations are  laid  down  concerning  the  prohibition  of  any 
procedure  which  will  interfere  with  child-bearing  in  any 
way.  The  attitude  of  the  public  and  even  of  churchmen 
is  undergoing  a change  concerning  birth  control.  At 
present  contraceptive  information  and  devices  are  allowed 
to  be  sent  through  the  mails.  Recently  there  was  a con- 
ference in  Washington  on  birth  control  and  the  problem 
was  taken  up  and  discussed  from  various  angles.  Our 
leading  gynecological  periodicals  of  today  are  filled  with 
advertisements  of  manufacturers  of  various  controcep- 
tive  devices.  In  Russia,  which  we  regard  as  the  acme 
of  radicalism,  abortion  is  legalized,  and  is  a function  of 
the  State.  It  is  evident  therefore,  that  there  is  a chang- 
ing trend  of  thought  in  respect  to  this  problem.  How- 
ever, I believe  that  the  physician,  because  of  the  peculiar 
place  which  he  occupies  in  the  community,  must  be 
rather  slow  in  advocating  this  doctrine,  as  I discovered 
some  time  ago  to  my  grief,  when  I helped  to  establish 
a birth  control  clinic  for  indigent  women,  physically  or 
socially  unfit  to  have  further  children.  There  was  a great 
deal  of  unfavorable  criticism  because  of  the  attempt  to 
establish  this  clinic. 

With  reference  to  operations  for  the  relief  of  injuries 
suffered  during  childbirth,  I do  not  think  the  surgeon 
has  completed  his  task  unless  he  has  taken  some  steps 
to  prevent  the  recurrence  of  these  injuries  through  sub- 
sequent pregnancies.  I believe  that  this  situation  should 
be  discussed  frankly  between  the  husband,  wife,  and  sur- 
geon before  operation,  and,  if  they  wish  to  accept  the 
responsibility  of  insuring  the  work  of  the  surgeon,  then 
the  surgeon  has  no  further  obligation.  But  if,  on  the 
other  hand,  the  family  is  sufficiently  large  and  the  patient 
asks  the  surgeon  to  take  those  steps  necessary  to  pre- 
vent a recurrence  and  second  operation,  then  I think  it 
is  up  to  the  surgeon  to  accede  to  her  wishes. 

It  is  important  when  this  is  done  that  whatever  is  car- 
ried out  should  be  performed  in  such  a way  that,  if,  in 
the  future,  under  some  special  conditions,  a pregnancy 
should  be  desirable  or  wanted,  a restoration  of  the  re- 
productive tract  could  be  effected.  This  is  important  from 
a psychological  standpoint  and  adds  considerably  to  the 
peace  of  mind  of  the  patient  to  know  that  this  is  possible 
should  she  desire  more  children. 

D.  E.  WHITE,  El  Dorado:  I enjoyed  Dr.  Jones'  paper. 
Like  Dr.  Krock  who  just  preceded  me,  I think  it  is  rather 
a delicate  subject  and  rather  a difficult  one  to  discuss. 
I also  agree  with  Dr.  Jones  that  the  term  "conservative 
vs.  radical"  is  a relative  term,  when  applied  to  surgery, 
and  various  meanings  are  applied  to  it  by  different  in- 
dividuals. I would  surmise  from  Dr.  Jones'  paper  that 
he  thinks  there  is  oftentimes  justification  for  birth  control 
from  an  economical  and  utilitarian  standpoint,  even 
tthough  it  became  necessary  to  resort  to  ligation  of  the 
Fallopian  tubes  or  salpingectomy.  I believe  that  there 
are  times  under  certain  conditions  when  possibly  we 
would  be  justified  but,  at  the  same  time,  a thing  like  that 
would  have  to1  be  worked  out  very  carefully  by  the  con- 
scientious physician  and  the  case  thoroughly  investigated. 
In  other  words,  it  would  not  do  to  let  down  the  bars,  so 
to  speak,  and  suggest  this  as  a general  rule.  I believe  it 
is  the  inherent  right  of  any  man  and  his  wife,  who  have 
some  two  or  three  children  and  do  not  care  to  have  any 
more,  to  so  arrange  if  possible  to  prevent  further  preg- 
nancies. This  is  a day  of  budgeting.  I believe  in  their 
family  budget  they  should  decide  how  many  children  they 


want  and  in  so  far  as  possible  hot  have  any  more.  But  I 
believe  that  you  can  resort  to  contraceptive  measures  a 
great  deal  of  the  time  and  prevent  surgical  interference. 
We  - have  several  contraceptive  measures,  with  which  I 
am  sure  you  are  all  familiar.  One  in  particular,  the  dia- 
phragm and  jelly  method  which,  I think,  is  a very  suc- 
cessful method.  I have  used  that  in  my  practice  for 
something  over  three  years  and  I have  found  it  prac- 
tically a hundred  per  cent  successful  where  the  directions 
are  really  properly  carried  out  by  the  patient. 

I enjoyed  Dr.  Jones'  paper  very  much,  and  I am  sure 
he  gave  us  all  something  to  think  about  in  this  time  of 
depression. 

T.  M.  FLY,  Little  Rock:  I just  want  to  say  that  one  of 
the  4hings  I do  not  understand  is,  how  Dr.  Jones,  or  any 
one  else,  can  tell  what  a woman  really  wants.  She  may 
think  she  does  not  want  more  children,  and  she  really 
does  want  them.  As  Henry  L.  Mencken  put  this  thing, 
when  a woman  finds  out  that  she  is  pregnant,  it  ought 
to  be  her  business  whether  she  wants  an  abortion  per- 
formed or  not.  That  is  what  is  called  radicalism.  I think 
very  few  people  here  will  come  out  in  the  open  and  agree 
with  him.  I think  on  the  other  hand,  99  per  cent  of  the 
people  here  will  agree  with  him  silently. 

DR.  JONES,  in  conclusion:  I may  not  have  lived  as 

long  as  some  of  my  colleagues,  but  I wonder  where  they 
think  I got  these  gray  hairs.  I appreciate  very  much  the 
liberal  discussion  my  paper  has  had.  I simply  want  to 
call  attention  again  to  the  fact  that  I stressed  the  idea 
that  the  terms  "radical"  and  "conservative"  are  merely 
relative.  Also,  I want  to  call  attention  again  to  the  fact 
that  I merely  suggested  the  right  of  determination  on 
the  part  of  the  patient,  which  is  consistency  in  our 
actions.  If  we  insist  on  the  right  of  determination  to  take 
added  risks,  why  are  not  we  consistent,  giving  the  woman 
the  right  of  determination  on  the  other  side  of  the  fence. 
It  has  been  said  that  this  is  a delicate  subject.  It  is 
indeed  a delicate  subject,  yet  I add  that  it  is  an  impor- 
tant subject.  You  will  notice  that  I gave  in  my  paper  no 
discussion  of  technique  or  methods  of  operation.  As  I 
said  in  my  preliminary  remarks,  it  is  simply  a paper  on 
trends:  trends  in  surgery.  I will  say  again  that  the  trend 
is  towards  a little  more  radical  surgery  in  the  female 
pelvis  if  the  patient  so  elects.  I thank  you. 

<$> 

RESOLUTION 

Whereas,  Dr.  Elam  H.  Stevenson,  an  honored 
and  esteemed  member  of  this  Society,  beloved 
by  all  who  knew  him,  passed  into  Eternity  on 
November  20,  1934,  be  it 

Resolved,  That  the  Sebastian  County  Medical 
Society  express  its  deep  regret  and  sorrow  and 
sense  of  loss  in  the  death  of  Dr.  Stevenson.  We 
shall  miss  his  cheerful  presence  and  wise  counsel. 
Be  it  also 

Resolved,  That  the  Society  extend  to  the  be- 
reaved family  our  deep  sympathy  and  that  a 
copy  of  these  resolutions  be  incorporated  in  the 
minutes. 

ARTHUR  F.  HOGE,  M.D. 

C.  H.  KENNEDY,  M.D. 

Committee. 


January,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


131 


THE  EFFECT  OF  QUININE  ON  THE 
SECOND  AND  EIGHTH  NERVES* 

J.  G.  MITCHELL,  M.D. 

El  Dorado 

In  formulating  a paper  on  the  subject  of  "The 
Effect  of  Quinine  on  the  Second  and  Eighth 
Nerves,"  I find  the  literature  to  be  somewhat 
limited  and  meager.  For  this  reason  it  has  been 
necessary  to  consult  the  opinion  and  experience 
of  some  of  my  colleagues  in  addition  to  the  lit- 
erature. There  seems  to  have  been  very  little  to 
appear  in  books  or  periodicals  on  this  subject 
for  the  past  ten  or  fifteen  years. 

It  is  an  accepted  fact  that  the  two  nerves  in 
question  are  considered  to  consist  of  the  most 
highly  organized  cells  of  the  human  body,  the 
olfactory  nerve  alone  excepted;  consequently,  it 
stands  to  reason  that  they  would  be  more  fre- 
quently affected  by  its  use  than  those  nerves 
with  less  highly-organized  cells.  We  know  quinine 
is  a protoplasmic  poison,  and  the  object  in  its 
administration  is  to  destroy  the  malarial  organism 
without  regard  to  its  effect  on  the  human  or- 
ganism. 

I recently  observed  a female  patient  about 
twelve  years  of  age  in  whom  there  was  vision 
for  form  only  existing.  The  drug  had  been  ad- 
ministered in  this  case  by  the  mother,  and  not 
upon  the  advice  of  the  doctor,  until  visual  dis- 
turbance appeared.  Other  than  a general  pallor 
I could  not  determine  any  abnormality  in  the 
fundi.  The  patient  was  of  a rather  neurotic  fam- 
ily; therefore,  I considered  her  to  have  an  idio- 
syncrasy to  the  drug.  On  suspension  of  the  drug, 
the  vision  became  apparently  normal  in  about 
two  weeks. 

I recall  observing  a patient  in  the  Charity 
Hospital  in  New  Orleans,  with  complete  quinine 
amaurosis.  This  patient  had  taken  the  drug  by 
unmeasured  doses  from  a tablespoon  over  a 
period  of  some  weeks.  I regret  that  it  was  not 
possible  to  follow  this  case  to  the  end.  It  is  evi- 
dent that  this  was  of  quite  frequent  occurrence 
some  fifteen  to  twenty-five  years  ago  before 
very  much  was  known  about  the  life-cycle  of  the 
malaria  plasmodia  and  before  intravenous  medi- 
cation was  used  in  smaller  and  more  accurately 
administered  doses  at  selected  intervals  before 
the  anticipated  paroxysm.  And,  too,  at  that  time 
there  was  more  or  less  self-medication  in  unmeas- 
ured dosage  by  the  uninformed  public. 

* Read  before  the  Fifty-ninth  annual  session  of  the 
Arkansas  Medical  Society,  held  in  Little  Rock,  April  16-18, 
1934. 


From  an  anatomical  and  clinical  standpoint, 
about  eighty  per  cent  of  all  writers  give  prac- 
tically the  same  version  of  the  production  of 
amblyopia;  that  is,  an  ischemia  of  the  retina  with 
pronounced  narrowing  of  the  retinal  vessels  and 
consequent  degeneration  of  the  ganglion  cells. 
Some  hold  that  the  retinal  condition  extends  on 
into  the  optic  nerve  proper  ending  in  an  optic 
neuritis.  Both  De  Schweinitz  and  Holden  have 
observed  practically  this  syndrome  in  experimen- 
tation with  animals.  De  Schweinitz  gives  the 
account  of  a patient  developing  amblyopia  from 
as  small  amount  as  12  grains.  Dr.  Scully  has 
noted  after  continuous  quinine  use  various  de- 
grees of  contraction  of  the  visual  field  and  dis- 
turbances of  color  vision.  In  fact,  practically  all 
writers  mention  this  phase  of  its  effect.  It  is 
claimed  that  complete  amaurosis  may  come  on 
very  suddenly  and  may  be  somewhat  transient. 
It  has  been  noticed  that  quite  often  the  vision 
will  increase  when  the  patient  lies  down.  This 
supports  the  theory  of  ischemia;  providing  the 
ischemia  does  not  last  too  long,  thereby  depriv- 
ing the  ganglion  cells  of  their  nourishment,  vision 
will  return  in  varying  degrees;  of  course,  in  pro- 
portion to  the  structural  damage  done. 

EFFECT  ON  THE  EIGHTH  NERVE.— It  is  not 
infrequent  to  have  a patient  come  in  the  office 
and  say,  "Doctor,  my  hearing  has  not  been  good 
since  I had  malaria  and  took  too  much  quinine." 
Or,  he  might  say  a certain  doctor  gave  him  too 
much  quinine.  It  is  my  experience,  however,  that 
the  majority  of  these  patients  will  fall  into  the 
progressive  type  of  deafness,  the  etiology  of 
which  is  not  well  known;  or  to  some  previous 
middle  ear  lesion;  although  I am  of  the  opinion 
that  a few  of  such  cases  are  due  to  the  effects 
of  quinine  on  the  auditory  nerve.  We  are  all 
well  aware  of  the  constancy  of  the  one  symptom 
of  tinnitus,  with  slight  deafness  following  the 
usual  therapeutic  dosage.  One  might  say  that 
this  is  the  result  of  all  who  take  quinine.  Under 
continued  use  the  deafness  may  be  almost  com- 
plete. 

It  is  not  well  understood  just  how  deafness  is 
produced.  Some  writers  claim  that  an  anemia  is 
produced;  others,  a hyperemia;  and  by  others  it 
is  thought  that  a direct  action  is  exerted  on  the 
nerve  structure.  If  the  quinine  administration  is 
continued,  permanent  deafness  may  result  either 
from  degenerative  changes  in  the  spiral  ganglia 
of  the  cochlea  or  from  a chronic  otitis  media 
arising  from  the  continued  congestion. 

It  might  be  comforting  to  those  who  entertain 
the  school  of  thought  that  quinine  produces  an 


132 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  8 


ischemia  in  the  labyrinth,  that  it  is  used  in  Me- 
niere's syndrome,  which  is  taught  by  some  to  be 
accompanied  by  a state  of  hyperemia.  Dr. 
Fletcher  states  that  he  has  observed  good  effects 
by  its  administration  in  Meniere's  syndrome. 

Dr.  H.  M.  Taylor,  of  Jacksonville,  Florida,  pub- 
lished an  article  in  the  Florida  State  Medical 
Journal  in  1933,  putting  forth  investigations  as  to 
the  possible  causes  of  congenital  deafness,  which 
might  be  attributed  to  the  use  of  quinine  in  the 
induction  of  labor.  In  doing  so,  he  procured  his- 
tories from  several  mothers  who  had  taken  quin- 
ine to  induce  labor,  who  consulted  him  in  con- 
genital deafness  cases,  and  in  these  cases  he 
found  that  in  nearly  all  instances  the  mother  had 
received  from  10  to  30  grains  of  quinine  during 
three  hours  prior  to  delivery.  Therefore,  he  con- 
cluded that  there  had  been  considerable  damage 
done  in  some  cases  by  the  administration  of 
quinine  to  expedite  labor.  He  mentions  many 
instances  of  reports  in  the  literature  of  fetal 
deaths  following  quinine  induction. 

CONCLUSIONS 

(a)  More  care  should  be  exercised  in  admin- 
istering quinine  to  neurotic  individuals. 

(b)  Undue  quinine  treatment  should  be  ab- 
stained from  in  all  industrial  workers,  more  par- 
ticularly trainmen  and  aeronautic  pilots. 

(c)  Dosage  to  induce  labor  should  be  limited. 

DISCUSSION 

L.  C.  McVay,  Marion:  I have  had  cases  that  have 

been  given  quinine  with  the  same  effect  that  the  doctor 
reported  to  us.  But  right  here  I believe  I will  report  a 
couple  of  cases  I have  had  recently  that  might  be  of 
interest  to  you.  They  were  very  interesting  to  me. 

A Chinese  woman  was  delivered  a few  days  before  of 
a fifth  child.  She  had  had  malaria  in  the  fall.  I intended 
to  give  her  ordinary  quinine  sulphate  but  she  told  me 
she  could  not  take  quinine,  so  I gave  her  two  grains  of 
quinine  with  one-sixth  of  a grain  of  plasmochin.  She 
took  one  dose.  She  sent  for  me  in  about  three  hours  after 
that,  thinking  she  was  going  to  die;  I thought  so,  too.  I 
made  several  visits  to  see  her.  She  did  not  complain 
of  any  deafness,  buf  she  was  not  able  to  get  her  breath. 
She  had  two  negro  women  rubbing  her  for  itching  and 
stinging  of  the  skin.  Her  rash  was  severe.  I gave  her 
adrenalin  immediately  and  it  relieved  her  symptoms  en- 
tirely but  for  only  a short  time.  All  her  symptoms  re- 
turned after  a few  hours.  I made  several  visits  before 
I was  able  to  relieve  her  symptoms. 

Another  case  was  that  of  a young  married  woman, 
operated  about  two  weeks  before  for  acute  appendicitis, 
with  no  bad  effects  following.  She  complained  of  a 
leucorrhea  she  had  for  some  time,  a trouble  her  mother 
also  seemed  to  have.  So,  while  she  was  in  the  hospital, 
a vaginal  smear  was  examined,  and  it  was  reported  that 


she  had  some  positive  organisms.  I used  a local  applica- 
tion of  15  grains  of  quinine-dichloride  in  the  vagina.  She 
lived  only  a few  doors  from  my  office.  Her  grandmother 
came  for  me  in  about  ten  minutes.  I was  busy,  and  she 
would  not  disturb  me.  In  about  twenty  minutes  she 
came  back  and  said  the  girl  was  not  doing  well,  that 
she  was  feeling  very  badly.  I went  over  immediately  and 
found  her  in  a rather  bad  condition.  She  was  cold  and 
as  white  as  could  be,  with  very  little  pulse.  She  was  a 
strong  healthy-looking  girl.  She  had  very  labored  breath- 
ing with  a temperature  in  a few  hours  to  103°.  She  had 
a temperature  of  104  and  a chill  the  next  morning.  I 
watched  to  see  whether  she  had  sqme  other  cause  for 
the  chill,  but  she  had  no  chill  or  fever  after  the  second 
day.  These  were  the  only  very  serious  effects  following 
the  use  of  quinine  I have  seen  in  25  years  practice  in 
the  delta. 

DR.  MITCHELL,  in  response:  As  to  the  effect  of 

quinine  on  the  patient  causing  rash,  I should  have  in- 
cluded the  matter  of  allergy  in  my  paper.  The  articles 
from  which  I drew  the  greater  part  of  my  information 
call  this  a neurotic  state.  I think,  as  we  know  it  now,  that 
all  of  the  allergic  tendencies  are  neurotic.  I believe  that 
is  one  thing  we  should'  look  and  not  wait  for  the  history 
the  patient  gives,  the  history  of  being  sensitive  to  quinine, 
but  just  ask  if  he  has  asthma,  hay-fever,  urticuria,  or  is 
sensitive  to  any  protein  or  pollen. 

: <$> 

Man  is  of  few  days  and  full  of  trouble.  He  laboreth 
all  the  days  of  his  youth  to  pay  for  a gasoline  chariot, 
and  when  at  last  the  task  is  finished,  Lo!  the  thing  is 
junk  and  he  needeth  another-  He  planteth  cotton  in  the 
earth  and  tilleth  it  diligently,  he  and  his  servants  and  his 
asses,  and  when  the  harvest  is  gathered  into  barns  he 
oweth  the  landlord  eight  dollars  and  forty  cents  more 
than  the  crop  is  worth.  He  borroweth  money  from  the 
lenders  to  buy  pork  and  syrup  and  gasoline  and  the 
interest  eateth  up  all  that  he  hath.  He  begets  sons  and 
educateth  them  to  smoke  cigarettes  and  wear  a white 
collar,  and  Lo!  they  have  soft  hands  and  neither  labor  in 
the  fields  nor  anywhere  under  the  sun.  The  children  of  his 
loins  are  ornery  and  one  of  them  becometh  a lawyer  and 
another  sticketh  up  a filling  station  and  maketh  whoopee 
with  the  substance  thereof.  The  wife  of  his  bosom  necketh 
with  a stranger  and  when  he  rebukes  her,  Lo!  she  shooteth 
him  in  the  finale.  He  goeth  forth  in  the  morning  on  the 
road  that  leadeth  to  the  city  and  a jitney  smiteth  him  so 
that  his  ribs  project  through  his  epidermis.  He  drinketh 
a drink  of  whoopee  juice  to  forget  his  sorrows  and  it 
burneth  the  lining  from  his  liver.  All  the  days  of  his  life 
he  findeth  no  parking  place  and  is  tormented  by  traffic 
cops  from  his  going  forth  until  he  cometh  back.  An 
enemy  stealeth  his  car;  physicians  remove  his  inner  parts 
and  his  teeth  and  his  bank  roll;  his  daughters  showeth 
their  legs  to  strangers;  his  arteries  hardeneth  in  the  even- 
ing of  life  and  his  heart  busteth  trying  to  keep  the  pace. 
Sorrow  and  bill  collectors  followeth  him  all  the  days  of 
his  life,  and  when  he  is  gathered  to  his  fathers  the  neigh- 
bors sayeth:  How  much  did  he  leave?  Lo!  he  hath  left 
it  all.  And  his  widow  rejoiceth  in  a new  coupe  and 
maketh  eyes  at  a young  sheik  that  slicketh  his  hair  and 
playeth  a nifty  game  of  bridge.  Woe  is  man!  From  the 
day  of  his  birth  to  the  time  when  earth  knoweth  him  no 
more,  he  laboreth  for  bread  and  catcheth  the  devil.  Dust 
he  was  in  the  beginning  and  his  name  is  mud. — Fountain 
Inn  (S.  C.)  Tribune. 


January,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


133 


THE  JOURNAL 

OF  THE 

ARKANSAS  MEDICAL  SOCIETY 


Owned  by  the  Arkansas  Medical  Society  and  Published 
under  direction  of  the  Council 


DR.  W.  R.  BROOKSHER,  Editor 
610  First  National  Bank  Bldg.,  Fort  Smith,  Arkansas 


The  advertising  policy  of  this  Journal  is  governed  by  the  rules 
of  the  Council  on  Pharmacy  and  Chemistry  of  the  American 
Medical  Association. 

All  communications  to  this  Journal  must  be  made  to  it  exclu- 
sively. Communications  and  items  of  general  interest  to  the  pro- 
fession are  invited  from  all  over  the  State.  Notice  of  deaths, 
removals  from  the  State,  changes  of  location,  etc.,  are  requested. 


OFFICERS  OF  THE  ARKANSAS  MEDICAL  SOCIETY 


F O.  MAHONY,  President  El  Dorado 

M.  E.  McCASKILL,  President-Elect  Little  Rock 

A.  M.  ELTON,  First  Vice-President  Newport 

S.  C.  FULMER,  Second  Vice-President  Little  Rock 

F.  D.  SMITH,  Third  Vice-President  Blytheville 

R.  J.  CALCOTE,  Treasurer  Little  Rock 

W.  R.  BROOKSHER,  Secretary Fort  Smith 


COUNCILORS 

First  District— W.  M.  MAJORS  Paragould 

Second  District — S.  J.  ALLBRIGHT  Searcy 

Third  District— M.  C.  JOHN  Stuttgart 

Fourth  District — C.  W.  DIXON  Gould 

Fifth  District— L.  L.  PURIFOY  El  Dorado 

Sixth  District — DON  SMITH  Hope 

Seventh  District — GEO.  B.  FLETCHER  Hot  Springs 

Eiqhth  District — S.  B.  HINKLE  Little  Rock 

Ninth  District — D.  L.  OWENS  Harrison 

Tenth  District— S.  J.  WOLFERMANN  Fort  Smith 


COMMITTEES 

(Appointments  expire  in  the  year  indicated.) 

Scientific  Work — L.  L.  Purifoy,  Chairman,  El  Dorado  (1935)-  R. 
B.  Robins,  Camden  (1936);  W.  R.  Brooksher,  Fort  Smith  (1937). 

Medical  Legislation — Val  Parmley,  Chairman,  Little  Rock 
(1937);  M.  L.  Norwood,  Lockesburg  (1937);  O.  L.  Williamson, 
Marianna  (1937);  H.  T.  Smith,  McGehee  (1936);  R.  L.  Smith, 
Russellville  (1936);  A.  S.  Buchanan,  Prescott  (1935);  H.  A.  Dish- 
on  g h , Little  Rock  (1935). 

Health  and  Public  Instruction — W.  B.  Grayson,  Chairman,  Little 
Rock  (1937):  S.  W.  Douglas,  Eudora  (1937);  B.  M.  Stevenson, 
Crawfordsville  (1937);  H.  K.  Carrington,  Magnolia  (1936);  H.  A. 
Stroud,  Jonesboro  (1936);  J.  H.  Fowler,  Harrison  (1935);  E.  J. 
Munn,  El  Dorado  (1935). 

Medical  Education  and  Hospitals — Joe  F.  Shuffield,  Chairman, 
Little  Rock  (1937);  David  Levine,  El  Dorado  (1936);  J.  B.  Futrell, 
Rector  (1935). 

Public  Relations — D.  A.  Rhinehart,  Chairman,  Little  Rock  (1937); 
E.  E.  Barlow,  Dermott  (1936);  M.  E.  McCaskill,  Little  Rock  (1935). 

Medical  Economics — I.  F.  Jones,  Chairman,  Fort  Smith  (1937); 
R.  B.  Robins,  Camden  (1937);  J.  E.  Neighbors,  Stuttgart  (1936); 
D.  E.  White,  El  Dorado  (1936);  Roy  Millard,  Dardanelle  (1935); 
A.  C.  Shipp,  Little  Rock  (1935);  R.  M.  Sloan,  Jonesboro  (1935). 

Scientific  Exhibit — F.  H.  Krock,  Chairman,  Fort  Smith  (1935); 
H.  King  Wade,  Hot  Springs  National  Park  (1936);  W.  E.  Gray, 
Jr.,  Little  Rock  (1937). 

Arrangements — (Host  Society  1935  meeting) — D.  W.  Goldstein, 
Chairman,  C.  S.  Holt,  J.  A.  Foltz,  H.  Moulton,  M.  E.  Foster, 
W.  G.  Eberle,  I.  F.  Jones. 

Necrology — W.  H.  Mock,  Chairman,  Prairie  Grove  (1935);  J. 
M.  Lemons,  Pine  Bluff  (1936);  H.  Moulton,  Fort  Smith  (1937). 

Auxiliary — L.  J.  Kosminsky,  Chairman,  Texarkana  (1935);  W.  T. 
Wootton,  Hot  Springs  National  Park  (1936);  C.  S.  Holt,  Fort 
Smith  (1937). 

Cancer  Control — D.  W.  Goldstein,  Chairman,  Fort  Smith  (1937); 
R.  L.  Saxon,  Little  Rock  (1936);  L.  A.  Purifoy,  El  Dorado  (1935). 


The  history  of  the  medical  profession  today 
has  reached  a crucial  point,  and  it  is  our  duty 
to  save  the  efficiency  of  a noble  profession,  that 
not  only  has  a great  past,  but  a still  greater 
future. 

— H.  E.  Sigeristin,  Bull.,  N.  Y.  Acad.  Med.,  Dec.,  1933. 


EDITORIAL 


MEMBERSHIP 

The  1935  membership  assessment  is  now  due 
from  every  member  of  the  Arkansas  Medical  So- 
ciety. Prompt  payment  of  this  small  fee  to  the 
county  secretaries  will  be  appreciated  and  will 
permit  these  officers  to  devote  to  the  other  ac- 
tivities of  organized  medicine  much  of  the  time 
formerly  spent  in  an  effort  to  secure  the  assess- 
ments of  some  members,  who,  for  an  unexplained 
reason,  do  not  pay  within  the  constitutional 
period.  Nineteen  thirty-five  promises  to  be  a 
year  in  which  medical  organization  must  have 
available  its  greatest  manpower,  must  attain 
greater  strength,  must  function  at  peak  effi- 
ciency. It  is  a year  in  which  liberal  demand  will 
be  made  of  the  time,  energy  and  ability  of  every 
physician  for  the  interests  of  organized  medicine. 
The  organization  must  be  strengthened  in  every 
way.  Therefore,  the  first  obligation  of  every 
member  is  to  pay  his  1935  assessment  now.  The 
next  obligation  is  to  interest  other  eligible,  worth- 
while physicians,  not  now  members,  in  affiliation 
with  the  organization.  Briefly,  we  summarize 
some  of  the  benefits  of  membership  in  the  Ark- 
ansas Medical  Society: 

1.  Maintenance  of  organization  machinery  for 
the  service  of  its  members. 

2.  An  aggressive  state  organization  for  the 
protection  of  its  members  and  the  public. 

3.  Proper  identification  of  the  professional 
status  of  a physician. 

4.  Subscription  to  The  Journal  of  the  Arkansas 
Medical  Society. 

5.  Attendance  at  society  and  clinical  meetings. 

6.  Medical  and  public  health  legislative  ac- 
tivities. 

7.  Requirement  to  membership  in  the  Amer- 
ican Medical  Association  as  well  as  the  special 
societies. 

8.  The  only  effective  medium  of  contact  be- 
tween the  medical  profession  and  the  public. 

9.  A means  for  cooperation  with  other  groups 
interested  in  the  common  problems  of  public 
health  and  professional  practice. 

MALPRACTICE  INSURANCE 

Approximately  4,000  malpractice  suits  are 
filed  yearly  against  physicians  in  the  United 
States  according  to  the  studies  of  Stetson  and 
Moran  who  have  reported  their  findings  in  The 
New  England  Journal  of  Medicine.  Such  a sit- 
uation demands  drastic  action  from  the  medical 


134 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  8 


profession  lest  it  become  a veritable  scourge. 
Numerous  factors  contribute  to  the  increase  in 
the  number  of  these  suits,  among  which  is  the 
present  economic  unrest. 

It  is  especially  important,  therefore,  that  every 
member  provide  himself  with  adequate  protec- 
tion against  this  evil.  Members  of  the  Arkansas 
Medical  Society  are  privileged  to  purchase  this 
protection  from  a reliable  insurance  carrier  at  a 
reasonable  premium.  No  complaint  against  this 
company's  management  of  members'  defense  has 
been  received. 

Unfortunately,  a number  of  Arkansas  physi- 
cians have  discontinued  this  protection  during 
the  past  year,  possibly  as  an  economy  move. 
This,  we  believe,  is  a short-sighted  policy.  The 
defense  of  one  action  in  court  alone,  verdicts 
disregarded,  will  cost  the  equivalent  of  many 
years'  premiums.  Your  professional  liability  in- 
surance is  a necessity;  it  is  a calm,  assuring  force 
should  you  become  the  defendant  in  such  an 
action.  Maintain  it  in  effect  to  the  last. 

| 

EDITORIAL  COMMENT 


Physicians  of  the  United  States  are  most  in- 
terested in  the  recommendations  of  the  Presi- 
dent's Committee  on  Economic  Security.  Mem- 
bers of  the  medical  profession  who  have  been 
called  upon  to  serve  in  an  advisory  capacity  on 
this  committee  are:  Harvey  Cushing,  Stewart  R. 
Roberts,  George  Crile,  Thomas  Parran,  James 
Alexander  Miller,  W.  L.  Bierring,  Robert  B.  B. 
Greenough,  George  M.  Pierson,  and  J.  Shelton 
Horsley.  In  addition  R.  G.  Leland,  of  the  Bureau 
of  Medical  Economics,  has  been  asked  to  serve 
as  a technical  consultant.  The  viewpoints  of 
these  physicians  on  so-called  socialized  medicine 
are  varying  and  will  insure  that  the  committee 
will  hear  all  sides  of  the  question. 

Unemployment  insurance  and  old  age  pen- 
sions appear  to  be  the  immediate  objectives  of 
the  presidential  plan  but  there  is  no  doubt  but 
that  legislation  will  be  introduced  proposing 
methods  for  the  medical  care  of  the  American 
people.  Just  what  provisions  will  be  embodied 
in  these  proposals  cannot  be  surmised. 

Physicians  owe  a duty  to  themselves  as  well  as 
a larger  duty  to  the  public  to  become  well- 
informed  on  systems  of  socialized  medicine  which 
are  now  in  effect  in  other  countries,  ascertaining 
whatever  there  may  be  of  merit  or  demerit  in 
such  plans.  The  public  will  expect,  and  right- 
fully so,  that  medical  men  will  be  best  informed 
on  these  matters. 


The  action  of  the  Sebastian  County  Medical 
Society  in  voting  for  a return  to  the  constitu- 
tional assessment  of  five  dollars  from  the  mem- 
bership by  the  state  society  is  encouraging  to 
the  officers  and  to  the  Council.  A comparison  of 
the  revenues  thus  obtained  was  discussed  in  the 
October  Journal.  Efficient  operation  of  the  or- 
ganization with  publication  of  The  Journal  can 
not  continue  on  the  present  three-dollar  assess- 
ment. Nineteen  thirty-five  promises  to  bring 
many  problems  affecting  the  practice  of  medi- 
cine and  medical  organization.  To  successfully 
cope  with  these  difficulties  will  require  expend- 
itures of  society  funds  in  excess  of  the  usual  op- 
erating expenses.  It  is  hoped  that  the  county 
societies  will  consider  the  good  of  the  organiza- 
tion in  this  matter  and  support  a movement  to 
restore  society  income  to  a normal  level. 

In  any  discussion  of  sickness  insurance  or  social- 
ized medicine,  three  facts  stand  out  in  the  med- 
ical viewpoint: 

1.  No  one  is  as  familiar  with  the  social,  finan- 
cial and  medical  needs  of  the  patient  as  his  con- 
fidential adviser  — his  physician. 

2.  If  paid  a living  wage,  the  employee  and 
his  physician  will  work  out  a method  of  providing 
needed  medical  service.  No  political  clerks  wilt 
be'  necessary  to  establish  or  maintain  this  rela- 
tionship, and  the  service  will  be  better,  more  sat- 
isfactory, and  cheaper. 

3.  Deterioration  of  the  quality  of  medical  ser- 
vice as  a result  of  unwise  interference  would 
harm  the  public  and  the  medical  profession. 

Members  are  urged  to  thoroughly  inform 
themselves  on  the  subject  of  socialized  medicine 
in  all  its  forms  in  order  that  they  may  intelligently 
present  the  views  of  organized  medicine  to  the 
lay  public,  legislators,  and  other  interested  per- 
sons. 


The  House  of  Delegates  of  the  Michigan  State 
Medical  Society  has  voted  not  to  experiment  at 
this  time  with  the  mutual  health  service  plan 
presented  by  its  committee  on  economics.  This 
is  perhaps  the  most  complete  plan  yet  evolved 
for  h ealth  services  differing  in  form  from  the 
present  physician-patient  relationship,  and,  since 
its  release,  has  been  the  subject  of  much  dis- 
cussion in  medical  councils.  Its  presentation  be- 
fore the  House  of  Delegates-  of  the  American 
Medical  Association  in  June  was  directly  re- 
sponsible for  the  adoption  by  that  body  of  the 
so-called  "Ten-Point  Plan,"  an  official  statement 
of  the  policies  of  the  national  organization. 


January,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


135 


The  discusson  in  Michigan  indicates  that  the 
general  sentiment  in  that  state  is  opposed  to 
change  in  the  traditional  manner  of  medical 
practice;  that  these  physicians  desire  to  main- 
tain their  independence,  to  control  their  prac- 
tice, and  to  have  opportunity  to  succeed  indi- 
vidually in  accord  with  personal  merit,  receiving 
such  remuneration  as  the  patient  is  able  to  give. 
This  is  undoubtedly  the  choice  of  the  majority  of 
the  physicians  of  the  United  States.  In  connec- 
tion with  plans  for  socialization  of  medicine,  the 
statement  of  G.  B.  Cutten,  President  of  Colgate 
University,  is  of  particular  interest:  "Will  it  be 
rugged  individualism  or  ragged  collectivism? 
We've  taken  better  care  of  the  idiot  than  we 
have  of  the  genius.  We  have  coddled  the  moron 
and  starved  the  intelligent.  Those  with  the  divine 
spark  have  been  neglected,  while  we  have  lav- 
ished money  and  training  upon  the  pinheads. 
Social  legislation  begs  the  unfit  to  become  more 
unfit  and  cordially  invites  the  fit  to  stop  the 
struggle  and  vegetate." 

Some  confusion  has  arisen  over  the  contradic- 
tory statements  in  the  letter  of  Dr.  S.  J.  Wolfer- 
mann,  Chairman  of  the  Council,  to  all  county  so- 
cieties on  November  12th,  and  a copy  of  a re- 
lief ad  ministration  circular  mailed  to  ail  advisory 
committeemen  by  the  state  secretary  on  Decem- 
ber 1st.  At  the  time  of  Dr.  Wolfermann's  let- 
ter, the  re  lief  administration  advised  that  no 
mileage  would  be  allowed  on  post-natal  visits. 
By  a later  regulation  on  December  1st,  this  was 
revised  to  permit  mileage  on  two  of  three  post- 
natal visits,  the  third  visit  to  be  made  to  the  phy- 
sician s office  four  to  six  weeks  after  delivery. 
Conflicts  such  as  these  in  regulations  of  the  state 
relief  administration  are  to  be  expected  from 
time  to  time  as  the  method  of  relief  changes. 
County  advisory  committeemen  are  advised  of 
ihese  changes  by  bulletin  or  letter  as  soon  as 
possible  by  the  state  secretary. 

<s> 

FROM  YOUR  LEGISLATIVE 
COMMITTEE 


To  the  Members  of  the  Arkansas  Medical 
Society: 

Soon  we  will  be  in  the  throes  of  a State,  as 
well  as  national,  legislative  session.  The  past  has 
taught  us  that  we  must  present  a united  front  in 
legislative  matters  affecting  Organized  Medi- 
cine. 


The  Organized  Medical  Profession  of  this  State 
asks  no  special  favors  of  the  State  Legislature, 
but  it  does  insist  upon  maintaining  the  high  stan- 
dard it  has  set  for  itself.  If  we  work  at  cross- 
purposes  within  our  own  ranks  we  are  certain  to 
lose  those  things  which  we  have  gained  in  the 
past.  Therefore  let  us  stand  together. 

If  the  future  may  be  judged  by  the  past  many 
bills  will  be  introduced  in  the  next  legislature  by 
various  groups  seeking  special  privileges  con- 
cerning the  practice  of  medicine  and  public 
health  matters.  These  bills  will  relate  to  osteop- 
athy, chiropractic,  anti-vivisection,  anti-vaccina- 
tion, principle  of  contract  practice,  employees' 
compensation,  compulsory  automobile  drivers' 
licenses  and  accident  insurance,  repeal  of  the 
Basic  Science  Law,  repeal  of  sections  of  the 
Medical  Practice  Act,  and  numerous  kindred  sub- 
jects. All  of  these  questions  and  many  others 
are  of  vital  interest  to  the  profession  of  this 
State. 

The  Druggists,  Dentists,  and  Hospital  Associa- 
tion will  stand  as  one  with  us  in  our  legislative 
battles  during  the  coming  session.  Members  of 
the  Legislative  Committees  of  these  organiza- 
tions will  meet  in  December  to  discuss  proposed 
legislation  and  methods  of  combating  such  legis- 
lation as  may  be  directed  against  any  or  all  of 
us.  Therefore  you  may  feel  free  to  discuss  in 
your  sections  and  counties  secure  in  the  knowl- 
edge that  we  are  working  hand  in  glove  together. 
With  the  help  of  these  allies  we  feel  that  we  can 
present  an  almost  impregnable  front  in  defend- 
ing our  position  on  any  subject  affecting  our 
several  professions. 

From  time  to  time  you  will  be  informed  by 
means  of  bulletins  on  legislative  matters  perti- 
nent to  our  several  professions.  Also  you  will  be 
called  upon  from  time  to  time  to  contact  your 
representatives  and  senators  either  personally,  by 
mail  or  by  wire.  We  hope  that  you  will  respond 
readily  for  you  may  rest  assured  that  if  called 
upon  for  such  contact  the  situation  will  demand 
quick  action. 

Constructive  suggestions  will  be  cheerfully  re- 
ceived by  the  members  of  your  committee.  Ad- 
dress all  communications  to  the  Chairman,  907 
Donaghey  Building. 

Fraternally, 

VAL  PARMLEY, 

Chairman  Legislative  Committee. 


136 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  8 


PROCEEDINGS  OF  SOCIETIES 

The  Ouachita  County  Medical  Society  was 
addressed  at  its  December  meeting  by  Drs.  A. 
Hutchinson,  C.  E.  Kitchens,  and  H.  E.  Murry,  of 
Texarkana. 

Washington  County  Medical  Society  has 
elected  the  following  officers:  President,  A.  A. 
Gilbert;  Vice  President,  J.  M.  Wallace;  Secre- 
tary-Treasurer, Fount  Richardson. 

Drew  County  Medical  Society  has  elected  the 
following  officers:  President,  A.  S.  J.  Collins; 
Vice  President,  G.  E.  DeBolt,  and  Secretary- 
Treasurer,  J.  S.  Wilson. 

Mississippi  County  Medical  Society  has  elected 
the  following  officers:  President,  R.  L.  Johnson; 
Vice  President,  W.  M.  Owen;  and  Secretary- 
Treasurer,  F.  D.  Smith. 

The  Tri-County  Clinical  Society  met  at  Hope 
on  November  27  for  the  following  program: 
"Fractures  and  Dislocations  in  the  Region  of  the 
Elbow,"  G.  A.  Caldwell  and  T.  M.  Oxford;  "Pre- 
ventative Orthodontia,"  H.  D.  Harper,  D.D.S.; 
"Heart  Block,"  M.  D.  Hargrove.  All  of  the 
speakers  were  from  Shreveport. 

— C.  K.  Townsend,  Secretary. 

The  twelfth  meeting  of  the  Fort  Smith  Clinical 
Society  was  held  November  22  with  the  follow- 
ing members  presenting  a program  of  operative 
and  dry  clinics  and  round-table  luncheon  talks: 
J.  W.  Amis,  A.  A.  Blair,  J.  H.  Buckley,  J.  A. 
Foltz,  M.  E.  Foster,  I.  F.  Jones,  F.  H.  Krock,  H. 
Moulton,  J.  C.  Ogden,  Pierre  Redman,  and 
H.  H.  Smith.  The  afternoon  guest  speakers  and 
their  subjects  were:  T.  H.  McCarley,  McAlester, 
Oklahoma,  "Pneumonia  in  Childhood;"  G.  B. 
Fletcher,  Hot  Springs  National  Park,  "Diagno- 
sis and  Treatment  of  Coarse  Tremor;"  and  Val 
Parmley,  Little  Rock,  "Shock  and  Burns  Due  to 
Electricity." 

The  dinner  meeting  of  the  Pulaski  County  Med- 
ical Society  November  19th  honored  F.  O.  Ma- 
hony,  President  of  the  Arkansas  Medical  Society. 
Additional  guests  of  the  society  for  this  meeting, 
which  is  to  become  an  annual  function,  were  the 
following  past-presidents  of  the  Arkansas  Med- 
ical Society:  E.  E.  Barlow,  Robert  Caldwell,  L.  J. 
KosmTnsky,  H.  Moulton,  F.  V insonhaler,  W.  T. 
Wootton,  and  D.  A.  Rhinehart,  and  President- 
elect M.  E.  McCaskill.  The  scientific  program, 
which  followed  an  address  by  President  Ma- 


hony,  was:  "Causes  of  Failure  in  the  Surgical 
Treatment  of  Gallbladder  Disease,"  Warren  H. 
Cole;  and  "Reduction  of  Mortality  in  Intestinal 
Obstruction,"  Robert  Elman,  both  assistant  pro- 
fessors of  surgery  in  Washington  University, 
Saint  Louis. 


Over  one  hundred  physicians  attended  the 
meeting  and  duck  dinner  of  the  Third  Councilor 
District  Medical  Society  at  Stuttgart  November 
27.  The  following  scientific  program  was  pre- 
sented: "Early  Diagnosis  of  Osteomyelitis,"  J.  S. 
Speed,  Memphis;  "Home  Treatment  of  Peptic 
Ulcer,"  J.  F.  John,  Eureka  Springs;  "Foreign 
Bodies  in  the  Auditory  Canal,"  Aris  W.  Cox, 
Helena;  and  "Studies  in  Tuberculosis"  (lantern 
slide  demonstration),  J.  D.  Riley,  State  Sanato- 
rium. Newly-elected  officers  are:  President,  Ruf- 
fin Longest,  Wynne;  Vice  President,  S.  S.  Beaty, 
England;  and  Secretary-Treasurer,  J.  O.  Rush, 
Forrest  City.  The  Society  will  next  meet  at  De- 
Valls  Bluff. 


Lawrence  County  Medical  Society  mel  at 
Black  Rock  November  13  as  the  guests  of  Drs. 
Cruse  and  Tibbels.  The  program  was  presented 
by  Battle  Malone  and  Battle  Malone,  II,  of 
Memphis,  and  Ralp  Sloan,  of  Jonesboro.  Dinner 
was  served  at  the  conclusion  of  the  scientific 
session. 

The  Fourth  Councilor  District  Medical  Society 
met  in  dinner  session  at  Monticello  December  3. 
The  program  was  as  follows:  "How  to  Collect 
Your  Bills,"  L.  C.  Barnes,  Hamburg;  "How  to 
Get  Prices  Back  to  a Normal  Level,"  C.  W. 
Dixon,  Gould;  "How  I Handle  Charity  Work," 
J.  A.  Thompson,  Dermott;  "The  Relation  of  the 
Physician  to  Public  Health,"  H.  T.  Smith,  Mc- 
Gehee,  and  "Cooperation  of  the  Physician  with 
Organized  Medicine,"  W.  R.  Brooksher,  Fort 
Smith. 

The  Eighth  Councilor  District  Medical  Society 
met  at  Little  Rock  December  5.  Morning  clinical 
sessions  were  conducted  at  St.  Vincent’s  Infirm- 
ary by  Drs.  S.  P.  Bond,  T.  D.  Brown,  Caldwell, 
Carruthers,  Dishongh,  S.  C.  Fulmer,  Gann,  Hig- 
gins, Hinkle,  H.  Fay  H.  Jones,  G.  V.  Lewis,  O.  C. 
Melson,  Roe,  Rodgers,  E.  H.  White,  and  J.  G. 
Watkins.  After  luncheon  the  program  was  con- 
tinued with  the  following:  "Appendicitis,"  A.  S. 
Buchanan,  Prescott;  "Impaired  Vision  and  Blind- 
ness in  Children,"  R.  J.  Calcote,  Little  Rock; 
"Principles  of  Treating  Some  Common  Types  of 
Fractures,"  J.  F.  Shuffield,  Little  Rock,  and  "Con- 
duct of  the  Normal  Labor  Case,"  W.  T.  Pride, 


January,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


137 


Memphis.  Officers  elected  were  H.  E.  Mobley, 
Morrilton,  President;  L.  Gardner,  Rusellville,  Vice 
President,  and  Alan  G.  Cazort,  Little  Rock,  Sec- 
retary-Treasurer. The  next  meeting  will  be  held 
in  Conway. 

The  Ninth  Councilor  District  Medical  Society 
met  at  Harrison  December  4 with  the  following 
scientific  program:  "Cancer  Problem,"  Dewell 
Gann,  Jr.,  Little  Rock;  "Early  Syphilis,"  S.  F. 
Hoge,  Little  Rock;  "Relief  Work  and  Its  Regu- 
lations," D.  L.  Owens,  Harrison;  "Urological 
Backache,"  H.  Fay  H.  Jones,  Little  Rock,  and 
"Some  Problems  of  Tuberculosis,"  J.  D.  Riley, 
State  Sanatorium.  A banquet  at  the  Hotel  Se- 
ville concluded  the  session. 

Lincoln  County  Medical  Society  has  elected 
the  following  officers:  President,  C.  W.  Dixon, 
Gould;  Vice  President,  R.  L.  Johnson,  Grady; 
Secretary-Treasurer,  Vernon  Tarver,  Star  City, 
and  Delegate,  G.  C.  Wood,  Grady. 

The  Sebastian  County  Medical  Society  met 
December  I I with  D.  W.  Goldstein  presenting 
"Film  Strips  on  Cancer  Control"  for  the  scien- 
tific program.  The  society  recorded  its  approval 
for  a return  by  the  state  society  to  the  constitu- 
tional assessment  of  five  dollars  yearly  from  the 
members.  Officers  elected  for  1935  are:  Pres- 
ident, F.  H.  Krock;  Vice  President,  J.  H.  Buck- 
ley;  Secretary,  L.  M.  Henry;  Treasurer,  W.  R. 
Brooksher;  and  Censor,  J.  H.  Buckley.  The  an- 
nual banquet  session  of  the  society  will  be  held 
January  8 with  the  following  committee  in 
charge:  C.  S.  Holt,  S.  J.  Wolfermann,  and  J.  H. 
Buckley. 

— J.  W.  Amis,  Secretary. 

The  Independence  County  Medical  Society 
met  in  dinner  session  December  10  at  Bates- 
ville.  The  scientific  program  was  as  follows: 
"Some  Problems  of  Tuberculosis,"  J.  D.  Riley, 
State  Sanatorium;  "Bums,"  V.  D.  McAdams, 
Cord;  and  "Pneumonia,"  F.  A.  Gray,  Batesville. 
Officers  elected  for  1935  are:  President,  V.  D. 
McAdams;  Vice  President,  C.  A.  Churchill;  Sec- 
retary-Treasurer, M.  S.  Craig;  Delegate,  O.  J.  T. 
Johnston,  and  Alternate,  L.  T.  Evans. 

— M.  S.  Craig,  Secretary. 
$> 

Dr.  and  Mrs.  B.  B.  Bruce,  Alma,  entertained  the 
Crawford  County  Medical  Society  and  guests 
at  dinner  December  18th.  The  following  were 
elected  officers  for  1935:  President,  S.  D.  Kirk- 
land, Van  Buren;  Vice  president,  Q.  R.  Galloway, 
Alma,  and  Secretary-treasurer  B.  B.  Bruce,  Alma. 


PERSONALS  AND  NEWS  ITEMS 


H.  H.  Smith,  Fort  Smith,  has  been  elected  an 
honorary  member  of  the  Tulane  University  chap- 
ter of  Omicron  Delta  Kappa,  national  honorary 
leadership  fraternity.  Dr.  Smith's  membership  is 
the  first  conferred  upon  an  alumnus  by  the  Tu- 
lane chapter. 

Dr.  R.  A.  Milliken,  formerly  of  Indianapolis, 
became  associated  with  Dr.  Val  Parmley  in  De- 
cember. 

Speakers  before  the  general  clinical  sessions 
of  the  Southern  Medical  Association  were:  Dew- 
ell Gann,  Jr.,  Little  Rock,  "A  Study  of  500  Con- 
secutive Cases  of  Appendicitis  and  Appendi- 
coses;"  S.  C.  Fulmer,  Little  Rock,  "Undulant 
Fever;"  and  O.  C.  Melson,  Little  Rock,  "Jaun- 
dice As  a Symptom."  Speakers  before  special 
sections  were:  W.  B.  Grayson,  Little  Rock,  "The 
Problem  of  Rabies;"  George  V.  Lewis,  Little 
Rock,  "Hemolytic  Jaundice;"  E.  I.  Thompson, 
Little  Rock,  J.  E.  Stevenson,  and  F.  H.  Krock, 
Fort  Smith,  "Xanthoma  Diabeticorum;"  and  H.  S. 
Thatcher,  Little  Rock,  "The  Pathology  of  "Avi- 
aminosis"  (Chairman’s  address). 

Dr.  Jacques  Forestier,  Aix-le-Bains,  France,  ad- 
dressed a special  meeting  of  the  Pulaski  County 
Medical  Society,  in  November  on  "State  Med- 
icine in  France." 

Mississippi  County  Medical  Society  is  again 
the  first  society  to  submit  report  and  dues  of 
members  for  1935,  F.  D.  Smith,  Blytheville,  Sec- 
retary, submitting  his  report  on  December  6 for 
the  following  members:  D.  L.  Boyd,  N.  B.  Ellis, 
T.  F.  Hudson,  F.  L.  Husband,  R.  L.  Johnson,  I.  R. 
Johnson,  W.  M.  Owen,  J.  T.  Polk,  F.  D.  Smith, 
J.  L.  Tidwell,  and  C.  E.  Wilson.  At  this  time  the 
dues  of  a few  scattered  members  for  1935  have 
been  received  in  the  State  Secretary's  office  in 
addition  to  the  report  of  Mississippi  County. 

Physicians  with  their  wives  who  visited  Mexico 
following  the  Southern  Medical  Association  meet- 
ing were:  E.  L.  Beck,  F.  W.  Carruthers,  S.  C. 
Fulmer,  D.  W.  Goldstein,  H.  Fay  H.  Jones, 
George  V.  Lewis,  N.  J.  Latimer,  and  A.  W. 
Strauss. 

"Diverticula  of  the  Jejunum:  Report  of  Two 
New  Instances"  by  J.  S.  Levy  and  A.  DeGroat, 
Little  Rock,  appears  in  the  December  issue  of 
the  American  Journal  of  Digestive  Diseases  and 
Nutrition. 


138 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  8 


Ira  Ellis,  Monette,  has  been  elected  Associate 
Grand  Patron  of  the  Grand  Chapter  of  Arkansas 
Order  of  Eastern  Star. 


The  Journal  offers  congratulations  on  the  ar- 
rival of  Clyde  Dudley  Rodgers,  Jr.,  on  November 
23. 


The  Southeast  Arkansas  Rotary  Conference 
was  held  at  Monticello  December  20  under  the 
chairmanship  of  Stanley  M.  Gates,  Monticello. 
Dr.  F.  W.  Carruthers  addressed  this  meeting  on 
"The  Crippled  Child  Problem." 

Dr.  A.  S.  Buchanan,  Prescott,  Secretary,  The 
State  Medical  Board  of  the  Arkansas  Medical 
Society,  has  asked  all  physicians  who  hold  cer- 
tificates of  this  board  dated  May,  1932,  or  1933, 
to  return  these  certificates  to  him  in  order  that 
their  names  may  be  re-engrossed  thereon  in  a 
more  durable  ink.  Should  other  certificate  hold- 
ers note  fading  of  names  on  their  certificates, 
they  are  also  requested  to  return  them  for  this 
re-engrossing. 

Bids  will  be  opened  January  3 for  the  con- 
struction of  a hospital  at  Dermott  for  which  a 
PWA  loan  of  $85,500.00  has  been  approved. 
The  hospital  will  be  of  27-bed  capacity  and  will 
be  operated  by  the  Benedictine  Sisters. 

Members  of  the  Radiological  Society  of  North 
America  who  attended  its  session  in  Memphis  in 
December  were:  George  F.  Jackson,  B.  A.  Rhine- 
hart,  D.  A.  Rhinehart,  Little  Rock;  J.  S.  Wilson, 
Monticello;  and  W.  R.  Brooksher,  Fort  Smith. 

In  an  impressive  ceremony  by  the  Grand 
Lodge  of  Arkansas  Masons,  the  cornerstone  of 
the  building  of  the  University  of  Arkansas  School 
of  Medicine  was  laid  November  20.  The  prin- 
cipal address  was  delivered  by  Senator  Joe  T. 
Robinson  and  additional  addresses  were  made 
by  Governor  Futrell,  former  Governor  George 
W.  Donaghey,  Hon.  D.  D.  Terry,  and  H.  M.  Ben- 
nett. Dr.  Frank  Vinsonhaler  presided  over  the 
meeting  and  the  Masonic  ceremony  was  in 
charge  of  W.  A.  Thomas,  the  grand  master,  as- 
sisted by  other  grand  lodge  officials. 

Commissions  as  First  Lieutenants,  Medical  Re- 
serve Corps,  have  been  issued  Jeff  Baggett, 
Prairie  Grove,  and  T.  D.  Brown,  Little  Rock. 

Drs.  H.  H.  McAdams  and  R.  H.  Willett  h ave 
erected  a 14-room  clinic  building  for  their  occu- 
pancy at  Jonesboro. 


The  following  have  changed  locations:  Oscar 
Barksdale,  from  Wilson  to  West  Memphis;  H.  G. 
Heller,  from  Foreman  to  Mena,  and  B.  M.  Ste- 
venson, from  Crawfordsville  to  West  Memphis. 

C.  S.  Paddock,  formerly  of  Fayetteville  but 
now  practicing  in  Memphis,  addressed  the  Craig- 
head-Poinsett  County  Medical  Society  Novem- 
ber 8 on  "Renal  Calculus  Disease." 

I 

Arkansas  physicians  in  attendance  at  the  meet- 
ing of  the  Southern  Medical  Association,  held 
in  San  Antonio,  November  13  to  16,  were: 

T.  E.  Benton,  Lonoke;  E.  A.  Callahan,  Carlisle;  F.  W. 
Carruthers;  B.  F.  Casada,  Hot  Springs  National  Park; 
A.  G.  Cazort,  Little  Rock;  Noel  Copp,  Calico  Rock; 
W.  G.  Eberle,  Fort  Smith;  W.  A.  Fowler,  Fayetteville; 
W.  N.  Freemeyer,  Little  Rock;  S.  C.  Fulmer,  Little  Rock; 
W.  M.  Gibson,  Nashville;  D.  W.  Goldstein,  Fort  Smith; 
W.  B.  Grayson,  Little  Rock;  C.  G.  Hinkle,  Batesville; 
A.  A.  Hughes,  Pine  Bluff;  H.  Fay  H.  Jones,  Little  Rock; 
A.  W.  Keith,  Stamps;  A.  C.  Kolb,  Hope;  L.  J.  Kosminsky, 
Texarkana;  N.  J.  Latimer,  Corning;  B.  V.  Lewis,  Little 
Rock;  P.  L.  Mahoney,  Little  Rock;  Madeline  Melson, 
Little  Rock;  O.  C.  Melson,  Little  Rock;  H.  E.  Mobley, 
Morrilton;  W.  H.  Mock,  Prairie  Grove;  J.  A.  Moore,  El 
Dorado;  I.  N.  McCollum,  Conway;  M.  L.  Norwood, 
L.ockesburg:  C.  E.  Oates,  North  Little  Rock;  T.  G.  Por- 
ter, Hazen;  A.  R.  Power,  Hot  Springs  National  Park; 
C.  C.  Reed,  Jr.,  Little  Rock;  Fount  Richardson,  Fayette- 
ville; B.  L.  Robinson,  Little  Rock;  D.  V.  Smith,  Huttig; 
E.  M.  Smith,  Hot  Springs  National  Park;  Morgan  Smith, 
Little  Rock;  P.  M.  Smith,  Magnolia;  W.  F.  Smith,  Little 
Rock;  A.  W.  Strauss,  Little  Rock;  H.  S.  Thatcher,  Little 
Rock;  E.  I.  Thompson,  Little  Rock;  and  W.  T.  Wootton, 
Hot  Springs  National  Park. 

Thomas  Watson,  Benton,  addressed  the  Mal- 
vern Rotary  Club  December  6 on  the  work  of  the 
county  health  unit. 

Howell  Brewer,  Hot  Springs  National  Park, 
was  elected  Vice  President  of  the  Arkansas  Na- 
tional Guard  Association  on  December  9. 

"The  Pathology  of  Avitaminosis"  by  H.  S. 
Thatcher,  Little  Rock,  appears  in  the  December 
Southern  Medical  Journal. 

Ira  Ellis,  Monette,  and  W.  M.  Majors,  Para- 
gould,  addressed  the  Greene  County  Medical 
Society  December  13th. 

In  attendance  at  the  Conference  of  the  Mem- 
phis Society  of  Ophthalmology  and  Otolaryn- 
gology on  December  I I were:  N.  B.  Burch,  Hot 
Springs  National  Park;  R.  J.  Calcote,  Little  Rock; 
Raymond  Cook,  Little  Rock;  A.  W.  Cox,  Helena; 
O.  H.  King,  Hot  Springs  National  Park;  H.  J.  G. 
Koobs,  Rogers;  J.  C.  Ogden,  Fort  Smith,  and 
J.  A.  Saliba,  Blytheville. 


January,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


139 


OBITUARY 


CHARLES  EDWARD  PARK,  of  DeWitt,  aged 
57,  died  in  a Memphis  Hospital  November  20. 
He  had  practiced  at  DeWitt  since  his  gradu- 
ation from  the  Saint  Louis  University  School  of 
Medicine  in  1903.  In  addition  to  his  membership 
in  the  county  and  state  medical  society,  he  was 
a member  of  the  Masonic  Lodge  and  of  the 
Rotary  Club.  He  is  survived  by  his  wife,  one 
daughter,  and  two  brothers. 


ELAM  HENSLEY  STEVENSON,  aged  78,  died 
at  Fort  Smith  November  20  following  a heart 
attack  on  November  16.  He  was  born  in  Giles 
County,  Tennessee,  on  July  22,  1856,  and  grad- 
uated in  1879  from  the  Eclectic  Medical  Institute 
of  Cincinnati.  On  February  9,  1933,  he  com- 
pleted fifty  years  of  practice  in  Fort  Smith,  but 
had  previously  practiced  for  a few  years  at 
Beebe  Rock,  Arkansas.  Throughout  his  life  he  had 
been  active  in  the  religious,  civic  and  medical 
activities  of  the  city,  serving  for  fifty-one  years 
as  a member  of  the  Board  of  Stewards  of  the 
First  Methodist  Church,  as  a founder  and  direc- 
tor of  the  first  hospital  in  Fort  Smith,  and  was 
a member  of  the  Lions  Club,  and  of  the  Knights 
of  Pythias  and  the  Odd  Fellows.  A former  Pres- 
ident of  the  National  Eclectic  Medical  Associa- 
tion, he  became  a member  of  the  Arkansas  Med- 
ical Society  in  1929.  His  outstanding  contribu- 
tion to  organized  medicine  in  Arkansas  was  his 
work  in  securing  the  passage  of  the  basic  science 
law.  He  is  survived  by  his  son,  Dr.  J.  E.  Steven- 
son, who  had  been  associated  with  him  in  prac- 
tice for  over  twenty-seven  years;  Mrs.  J.  E. 
Stevenson;  a sister,  Mrs.  Sterling  Loyd,  of  Mem- 
phis; and  three  grandsons. 


AUXILIARY  NEWS 


ALL  GOOD  WISHES  FOR  A HAPPY  AND 
PROSPEROUS  1935 


The  medical  auxiliary  of  Bowie  and  Miller  counties  met 
with  Mrs.  T.  F.  Kittrell,  November  23.  The  cohostesses 
were  Mrs.  L.  H.  Lanier,  Mrs.  L.  P.  Goode,  and  Mrs.  P.  H. 
Phillips,  of  Ashdown. 

Mrs.  Decker  Smith,  president,  led  the  meeting,  at  which 
time  plans  were  made  to  follow  the  usual  custom  filling 
Christmas  stockings  for  the  United  Charity.  A Christmas 


party  for  the  doctors  and  their  wives  was  also  planned, 
to  be  held  at  the  McCartney  Hotel  on  December  28. 

The  guest  speaker  for  the  afternoon,  Dr.  H.  E.  Murry, 
spoke  on  "Health  Legislation  in  Arkansas." 

Mrs.  Ralph  Cross,  bride  of  Dr.  R.  C.  Cross,  was  also 
a guest  of  the  Auxiliary. 


The  Auxiliary  to  the  Cross  County  Medical  Society 
was  organized  on  November  2 at  the  home  of  Mrs.  L.  H. 
Lipsey  in  Wynne.  There  were  seven  members  present. 
The  following  officers  were  elected:  President,  Mr.  Austin 
F.  Barr,  Cherry  Valley;  Vice  President,  Mrs.  Thomas  Wil- 
son, Wynne;  Secretary-Treasurer,  Mrs.  J.  S.  Miller,  Par- 
kin. The  Auxiliary  plans  to  hold  its  meetings  on  the  first 
Friday  of  each  month.  On  November  6,  the  Auxiliary  was 
honored  with  a visit  from  Mrs.  William  Hibbitts  at  the 
home  of  Mrs.  Thomas  Wilson  in  Wynne.  Mrs.  Hibbitts 
talked  to  us  about  the  work  and  purpose  of  the  Auxiliary. 
The  membership  of  the  Auxiliary  is  small,  but  we  hope  to 
have  more  members  later,  and  after  Mrs.  Hibbitts'  very 
interesting  and  inspirational  talk  with  us,  we  hope  that 
the  Auxiliary  can  carry  on  its  intended  work. 


The  Southern  Medical  Auxiliary  meeting  in  San  An- 
tonio was  most  interesting  and  enjoyable.  Our  President, 
Mrs.  William  Hibbitts,  served  as  Secretary  for  the  entire 
meeting.  Arkansas  was  well  represented.  Those  regis- 
tered were;  Mesdames  Noel  Copp,  Calico,  Rock;  E.  A. 
Callahan,  Carlisle;  T.  E.  Benton,  Lonoke;  A.  C.  Kolb, 
Hope;  H.  F.  Jones,  Little  Rock;  C.  G.  Hinkle,  Batesville; 
William  Hibbitts,  Texarkana;  W.  B.  Grayson,  Little  Rock; 
D.  W.  Goldstein,  Fort  Smith;  F.  Richardson,  Fayetteville; 
T.  G.  Porter,  Hazen;  H.  E.  Murry,  Texarkana;  N.  J. 
Latimer,  Corning;  Euclid  Smith,  Hot  Springs  National 
Park;  W.  F.  Smith,  Little  Rock;  A.  W.  Strauss,  Little 
Rock;  W.  T.  Wootton,  Hot  Springs  National  Park;  S.  C. 
Fulmer,  Little  Rock;  M.  V.  Russell,  El  Dorado;  L.  J.  Kos- 
minsky,  Texarkana;  Charles  E.  Oates,  Little  Rock;  M.  M. 
Melson,  Little  Rock;  P.  M.  Smith,  Magnolia;  F.  W.  Car- 
ruthers,  Little  Rock,  and  W.  N.  Freemyer,  Little  Rock. 


The  Obstetrical  Pack  Committee  to  the  Pulaski  County 
Medical  Society  met  November  14,  at  the  home  of  Mrs. 
R.  A.  Law  where  15  kits  were  assembled  under  the  direc- 
tion of  Mrs.  F.  E.  Hurrle,  sub-chairman.  Members  pres- 
ent included  Mesdames  J.  B.  Crawford,  President  of  the 
Auxiliary;  Byron  A.  Bennett,  L.  F.  Barrier,  W.  R.  Richard- 
son, G.  F.  Jackson,  and  D.  M.  Switzer.  Dainty  refresh- 
ments were  served  by  the  hostess. 


The  November  meeting  of  the  Auxiliary  to  the  Pulaski' 
County  Medical  Society  was  held  at  the  home  of  Mrs. 
H.  W.  Hundling,  November  21.  Mrs.  T.  W.  Brown,  Mrs. 
W.  M.  Matthews,  Mrs.  G.  D.  Kenney,  and  Mrs.  Paul  Ma- 
honey served  as  co-hostesses.  Mrs.  E.  T.  Browne  reviewed' 
Ruth  Sockow's  "The  Folks."  During  the  tea  hour  Mrs. 
W.  R.  Bathurst  and  Mrs.  George  Jackson  presided. 


The  Auxiliary  to  the  Washington  County  Medical  So- 
ciety was  organized  December  Nth  at  a dinner  session 
held  at  the  Washington  Hotel,  Fayetteville.  Mrs.  Wm. 
Hibbitts,  State  President,  was  in  attendance  to  perfecb 
the  organization. 


140 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  8 


BOOK  REVIEWS 


Synopsis  of  Genitourinary  Diseases.  By  Austin  I.  Dod- 
son, M.D.,  F.A.C.S.,  Professor  of  Genitourinary  Surgery, 
Medical  College  of  Virginia;  Genitourinary  Surgeon  to 
the  Hospital  Division,  Medical  College  of  Virginia;  Urol- 
ogist to  St.  Elizabeth's  and  St.  Luke's  Hospitals  and  to 
the  McGuire  Clinic.  Pp.  265  with  I I I illustrations.  Price 
$3.00.  Saint  Louis:  The  C.  V.  Mosby  Company,  1934. 

This  book  is  in  compend  form  presenting  the  essential 
facts  connected  with  urology.  The  signs  and  symptoms, 
the  instruments,  the  anatomy,  the  anomalies,  and  the 
principal  lesions  of  the  genitourinary  system  are  covered 
in  a concise,  lucid  manner-  The  numerous  illustrations, 
practically  all  of  which  are  diagrammatic,  are  most  sat- 
isfactory for  the  comprehension  of  the  subjects  treated. 

Diseases  Peculiar  to  Civilized  Man:  Clinical  Manage- 
ment and  Surgical  Treatment.  By  George  W.  Crile,  M.D. 
Edited  by  Amy  Rowland.  Pp.  427.  41  illustrations.  Price 
$5.00.  New  York:  The  Macmillan  Company,  1934. 

This  volume  represents  a tremendous  amount  of  work  in 
its  compilation  and  is  a distinctly  new  theme  in  medical 
subjects.  It  is  concerned  with  the  clinical  management 
and  surgical  treatment  of  certain  diseases  which  are  rec- 
ognized as  being  peculiar  to  civilized  man.  These  are 
hyperthyroidism,  neurocirculatory  asthenia,  persistent  pep- 
tic ulcer,  and  certain  cases  of  diabetes  and  epilepsy. 
The  stress  and  strain  of  civilization  are  considered  causal 
factors  in  these  so-called  "kinetic"  diseases.  Crile  be- 
lieves they  are  due  to  an  abnormally  high  sustained  ac- 
tivity of  the  adrenal-sympathetic-thyroid  system  and  he 
recounts  his  efforts  to  control  these  disturbances  by  sur- 
gery of  the  adrenal  gland.  His  series  now  totals  over 
300  cases  and  approximately  one-half  of  the  volume  is 
devoted  to  the  detailed  case  histories  of  individuals  who 
have  had  such  surgical  intervention.  The  technic  of  adre- 
nal denervation  is  fully  described. 


Definite  Diagnosis  in  General  Practice.  By  W.  L.  Kitch- 
ens, M.D.  With  a Foreword  by  John  H.  Musser,  B.S., 
M.  D.,  F.A.C.P.,  Professor  of  Medicine  in  The  Tulane  Uni- 
versity of  Louisiana  School  of  Medicine.  Large  Octavo  of 
1,000  pages.  Philadelphia  and  London:  W.  B.  Saunders 
Company,  1934.  Cloth,  $10.00  net. 

The  purpose  of  this  book  is  stated  to  be  threefold: 
(I)  For  use  as  a quick  reference,  (2)  as  a simplified 
differential  diagnosis,  and  (3)  as  a "selective  diagno- 
sis." 506  symptoms  of  definite  diagnostic  significance  in 
some  407  disease  entities  are  considered.  The  diseases 
are  those  to  be  met  with  in  a wide  and  varied  practice. 
The  reader  may  quickly  review  the  symptomatology  of  a 
given  disease;  or  with  a given  symptom,  those  diseases  in 
which  the  symptom  is  of  diagnostic  importance  may  be 
readily  found.  It  is  in  the  field  of  differential  or  "selec- 
tive" diagnosis,  however,  that  the  book  offers  its  greatest 
value  to  the  practitioner.  The  arrangement  permits  a 
comparison  of  the  symptomatology  of  one  disease  with 
that  of  another  in  an  especially  advantageous  manner. 
While  not  a "royal  road  to  learning,"  the  volume  certainly 
offers  appreciated  assistance  in  diagnosis.  A unique 
feature  is  the  provision  which  has  been  made  for  the 
addition  of  symptoms  from  the  reader's  personal  obser- 
vations to  those  compiled  by  the  author,  and  for  new 
diagnostic  points  as  they  may  be  established  from  time 
to  time.  The  physician  who  employs  this  volume  routinely 
will  find  that  diagnosis  is  facilitated  while  his  acquaint- 
ance with  differential  points  becomes  enlarged. 


The  Surgical  Clinics  of  North  America.  (Issued  serially, 
one  number  every  other  month.)  Volume  14,  Number  5. 
Lahey  Clinic  Number  — October,  1934.  Octavo  of  260 
pages  with  72  illustrations.  Per  clinic  year,  February, 
1934,  to  December,  1934.  Paper,  $12.00;  Cloth,  $16.00 
net.  Philadelphia  and  London:  W.  B.  Saunders  Com- 
pany, 1934. 

This  issue  is  the  first  of  the  new  series  in  reporting 
different  clinics.  It  is  indeed  superior  to  the  previous 
issues.  All  rare  and  uninteresting  case  reports  are  omitted. 
The  new  series  lists  the  different  specialties  with  the  con- 
tributors to  that  branch.  We  are  able  to  follow  pre-  and 
post-operative  treatment  as  employed  by  the  authors,  in- 
stead of  the  reports  of  individual  cases  as  formerly.  This 
volume  presents:  the  medical  and  surgical  treatment  of 
peptic  ulcer;  the  technic  of  intratracheal  anesthesia;  jaun- 
dice and  its  management;  empyema;  the  use  of  skeletal 
traction;  the  treatment  of  plantar  warts;  hyperthyroidism; 
and  the  treatment  of  lingual  tonsils.  The  change  will 
prove  popular,  bringing  a larger  number  of  physicians  in 
contact  with  interesting  clinical  treatises  from  different 
authorities. 

— I.  F.  Jones. 


Minor  Surgery.  By  W.  Travis  Gibb,  M.D.,  Consulting 
Surgeon,  City  Hospital  and  Central  and  Neurological 
Hospitals;  Formerly  Attending  Surgeon,  Workhouse  and 
Penitentiary  Hospitals  and  Hospital  fop  the  Aged  and 
Infirm  Poor,  New  York  City.  Pp.  418  with  148  illustra- 
tions. Price  $5.00.  New  York:  Paul  B.  Hoeber,  1934. 

The  reviewer  is  pleased  to  know  that  minor  surgery  as 
met  with  in  everyday  practice  can  be  so  condensed  and 
practical.  The  author's  style  is  clear  and  explicit.  Technic 
is  fully  detailed.  The  fields  of  presurgical,  surgical,  and 
post-operative  care  are  covered.  The  prognosis  is  given  in 
all  instances.  Attention  is  given  to  removal  of  conditions 
which  impair  the  condition  of  the  patient  and  delay  re- 
covery. It  would  not  be  amiss  for  every  practitioner  to 
have  this  volume  within  reach  for  quick  reference  as  well 
as  for  interesting  reading. 

— O.  D.  Ward. 


Minor  Maladies.  By  Leonard  Williams,  M.D.  6th  Edi- 
tion, reprinted.  Pp.  393.  Price  $3.75.  Baltimore:  William 
Wood  and  Company,  1934. 

This  is  a common  sense  and  scientific  consideration  of  a 
few  of  the  more  common  ailments  which  confront  the 
general  practitioner.  Colds,  Indigestion,  Constipation  and 
Diarrhea  are  some  of  the  conditions  considered.  Many 
observations  that  aid  in  differential  diagnosis  not  found 
in  the  average  textbook  are  noted  in  this  volume.  It  is 
more  easily  read  than  is  the  usual  English  work.  Drug 
references  are,  of  course,  to  the  British  Pharmacopeia, 
but  it  is  believed  that  the  book  will  be  of  interest  to  the 
great  majority  of  physicians  in  this  State. 

Gynecology.  By  Brooke  M.  Anspach,  M.D.,  Professor 
of  Gynecology,  Jefferson  Medical  College,  Philadelphia. 
5th  Edition.  Pp.  812.  679  illustrations,  10  in  color.  Price 
$9.00.  Philadelphia:  J.  B.  Lippincott  Company,  1934. 

The  new  edition  of  Anspach's  "Gynecology"  has 
been  enlarged  and  in  part  rewritten  in  order  to  include 
recent  advances,  especially  in  physiology  and  disturb- 
ance of  gynecological  function.  New  chapters  include 
those  on  endometriosis;  sterilization  and  therapeutic  abor- 
tion; and  minor  surgical,  electro-thermic,  mechanical  and 
local  treatment.  A new  feature  is  the  chapter  on  consti- 
tutional types  and  endocrine  disorders. 


January,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


Ml 


The  work  is  practical  in  every  respect.  With  the  dis- 
cussion of  each  disease  are  given  both  clinical  and  lab- 
oratory methods  of  examination,  including  a description 
of  instruments  used  in  special  examinations.  The  text  is 
fully  illustrated.  Descriptions  of  operative  technic  are 
explicit  and  easy  to  follow.  Post-operative  care  is  given 
in  detail. 

A complete  and  up-to-date  bibliography  is  given  at 
the  end  of  each  chapter,  enabling  one  to  further  study 
recent  work,  especially  valuable  in  the  field  of  physiol- 
ogy and  the  endocrines. 

— Ruth  Ellis. 

$ 

ABSTRACT 

The  Treatment  of  Verrucae  by  Local  Injection  of  Bismuth. 

Harold  Shellow.  III.  Med.  Jour.,  Oct.  1934,  66;  332-336. 

The  aqueous  1.5  per  cent  solution  of  bismuth  sodium 
tartrate  was  employed  in  the  following  manner:  usual 
skin  preparation  by  soap  and  water,  iodine  and  alcohol; 
then  with  a fine  hypodermic  needle  the  skin  is  pierced 
just  outside  of  the  zone  of  hyperkeratosis,  directed  down- 
ward and  inward  to  the  base  of  the  verruca,  keeping  the 
end  of  the  needle  just  above  the  corium.  A good  deal 


of  force  will  be  required  for  the  injection  and  unless  this 
resistance  is  met,  the  solution  will  not  be  injected  at  the 
proper  site.  From  'A  to  2 minims  are  injected,  according 
to  the  size  of  the  lesion.  In  from  I to  3 days  a dark 
hemorrhagic  area  appears,  visible  through  the  keratotic 
growth,  and  in  most  cases  there  is  either  complete  ces- 
sation or  diminution  of  pain.  If  within  7 to  14  days 
following  the  appearance  of  the  hemorrhagic  center  the 
verruca  has  not  disappeared  or  the  central  portion  has 
not  fallen  out,  the  keratotic  tissue  can  be  removed  to 
determine  if  activity  is  still  present.  In  most  instances 
an  underlying  normal  appearing  epidermis  will  be  re- 
vealed. If  after  two  weeks  of  further  observation,  an 
active  verrucous  tissue  is  seen,  the  lesion  can  be  rein- 
jected. The  epidermis  is  usually  normal  in  from  four  to 
eiaht  weeks  after  the  first  injection.  97  lesions  occur- 
ring in  73  patients  were  treated  by  the  author;  89  were 
cured,  5 improved,  3 showed  no  improvement,  42  cases 
required  but  one  injection.  Since  verrucae  are  known  to 
involute  frequently  after  any  type  of  trauma,  32  lesions 
were  injected  locally  with  normal  saline  as  a control.  29 
of  these  showed  no  change  after  3 injections  while  3 
lesions  disappeared. 


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Stone,  Am.  Jour.  Physical  Therapy,  April,  1932. 

Jacobs,  St.  Louis  Med.  Soc.  Bulletin,  Discussion  by  Vaughan 
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THE  JOURNAL 

of  the  ARKANSAS  MEDICAL  SOCIETY 

PUBLISHED  MONTHLY  UNDER  DIRECTION  OF  THE  COUNCIL 


Vol.  XXXI 


FORT  SMITH,  ARKANSAS,  FEBRUARY,  1935 


No.  9 


COLON  DYSFUNCTION* 


Henry  Gordon  Rudner,  M.  D.,  F.  A.  C.  P., 
Memphis 


It  is  with  difficulty  that  we  define  a syndrome 
so  varied  as  that  of  colonic  dysfunction,  when  so 
often  in  the  majority  of  cases  the  colonic  dysfunc- 
tion is  only  a manifestation  that  is  basically  sys- 
temic in  origin. 

The  term  mucous  colitis  should  be  excluded 
from  the  discussion  of  colonic  dysfunction,  be- 
cause it  is  inaccurately  conceived,  and  arouses 
unwarranted  fear  in  the  minds  of  the  lay.  Colitis 
is  an  inflammatory  condition  of  the  colon,  and 
should  be  limited  to  the  inflammatory  diseases  of 
the  colon. 

Barker  defines  the  condition  as  an  enteropathy 
affecting  nervous  patients.  Jordon  defines  it 
as  a condition  in  which  musculo-neural  apparatus 
has  lost  its  co-ordination  and  correlated  func- 
tion. The  theories  as  to  the  etiology  are  legion. 
There  is  much  difference  of  opinion  about  its 
character,  and  no  agreement  as  to  its  etiology. 
Most  of  the  writers,  up  to  the  present  day,  as 
Bargen,  Jordon,  Bockus,  and  Brown,  agree  that 
the  condition  is  purely  neurogenic,  and  that  the 
mucous  produced  in  large  amounts  is  a hyperse- 
cretion, and  not  inflammation.  To  be  sure,  it  is 
the  routine  of  the  individual  super-imposed  upon 
a none  too  stable  nervous  system  that  produces 
the  irritable  colon,  and  the  condition,  once  es- 
tablished, causes  a vicious  circle. 

Those  of  us  who  have  followed  the  pioneers 
in  gastro-enterology  and  physiology  and  have 
watched  with  close  scrutiny  the  correlation  of 
the  clinician,  physiologist  and  bio-chemist,  have 
now  weathered  the  storms  and  revolutions  in 
medicine,  and  are  face  to  face  with  physiological 
truthfulness.  We  have  watched  the  continental 
surgeons  go  through  the  orgy  of  drastic  assaults 
to  the  abdomen,  eviscerations  and  pexys  in  deal- 
ing with  so-called  diseases  of  the  colon. 

To  such  men  as  Alvarez,  Howell,  Carlson,  Hurst 

* Read  before  the  Fifty-ninth  Annual  Session  of  the 
Arkansas  Medical  Society  held  in  Little  Rock,  April  16-18, 
1934. 


and  Cannon,  we  are  deeply  indebted  for  our 
knowledge  of  the  physiology  of  the  gastroin- 
testinal tract.  This  tract  is  certainly  a most  in- 
tricate piece  of  machinery.  Although  it  would 
seem  impossible  to  compare  this  machinery  with 
that  of  the  heart,  nevertheless  it  has  almost  the 
same  nervous  mechanism  as  the  heart.  The 
nervous  mechanism  of  the  gastro-intestinal  tract 
is  initiated  by  the  indigestion  of  food;  the  py- 
lorus then  closes.  The  signal  is  then  sent  to  the 
ileo-cecal  valve,  and  it  opens,  allowing  the  fluid 
medium,  held  in  the  ileum,  to  pass  into  the 
cecum.  There  ensues  a contraction  of  the  recto- 
sigmoid. This  is  the  gastro-colic  reflex,  a normal 
mechanism,  occurring  after  each  meal.  When 
the  fluid  enters  the  colon,  it  causes  the  mass  in 
the  colon  to  move  by  direct  physical  effect,  and 
not  by  peristalsis. 

The  colon  is  divided  into  the  right  colon,  which 
has  to  do  with  absorption,  and  condensing;  and 
the  left  colon,  which  is  purely  a reservoir,  and 
normally  should  play  no  part  in  the  absorption 
of  anything  but  small  amounts  of  water,  dextrose 
and  salt.  So,  then  in  civilized  man,  the  function 
of  the  descending  colon  is  that  of  holding  fecal 
residue  until  it  can  be  conveniently  discharged, 
and  the  function  of  the  ascending  colon,  and 
right  half  of  the  transverse  colon  is  that  of  re- 
turning to  the  blood,  the  water  which  has  been 
poured  into  the  small  intestines  during  the  pro- 
cess of  digestion. 

Another  function  of  the  colon  is  that  of  ex- 
cretion of  heavy  metals,  and  other  substances, 
which  have  been  absorbed  higher  up  in  the 
bowel.  Certainly  it  is  possible  that  hypersensi- 
tivity of  the  colon,  which  so  often  occurs,  is  due 
to  the  excretion  of  poisonous  material  which 
produces  an  irritation  to  the  mucosa  of  the  de- 
scending colon.  The  nature  of  these  poisonous 
materials  is  not  yet  thoroughly  understood. 

The  colon  has  an  excretory  function,  as  proven 
by  Volt  and,  since  this,  many  investigators  have 
found  various  products  of  excretion  in  these  se- 
cretions, such  as  calcium,  iron,  magnesium  and 
phosphates.  Also,  bismuth  and  aluminum  have 
been  found.  The  fact  that  ulceration  in  the 
large  bowel  exists  so  commonly  in  bichloride  of 


144 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  9 


mercury  poisoning  proves  that  this  metal  is  so 
excreted. 

One  of  the  chief  secretions  of  the  colon  is 
mucous,  and  its  function  is  that  of  lubricant  to 
the  feces,  as  well  as  a protective  agent  to  the 
lining  of  the  large  intestine.  It  is  a protective 
agent  to  this  delicate  membrane,  and  acts  in  a 
mechanical  manner,  rather  than  a bacteriocidal 
agent. 

The  colon  is  not  at  all  indispensable.  It  has 
been  shown  many  times  that  it  can  be  removed 
in  its  entirety,  and  after  a short  period  of  time 
the  ileum  becomes  adapted  to  the  retention  of 
fecal  matter,  and  acts  as  a reservoir.  A very 
interesting  observation  proved  that  the  so-called 
mucous  colitis  is  not  a diseased  entity  of  the 
colon.  A patient's  colon  was  removed,  in  an 
attempt  to  cure  mucous  colitis,  and  the  patient 
continued  to  have  mucous  colitis  with  all  of  its 
symptoms  as  before  the  operation. 

Although  the  mechanism  of  this  important  tub- 
ing has  the  power  of  absorption  to  a certain  de- 
gree, the  left  colon  was  not  intended  for  absorp- 
tion. I may  add  that  the  left  colon  of  today  has 
been  "educated"  to  perform  the  function  of  ab- 
sorption. Considerable  irritation,  chemical,  me- 
chanical and  pathological,  is  required  to  bring 
about  the  type  of  tonus  necessary  for  the  seg- 
ments to  initiate  areas  of  stimulation  with  re- 
sultant contractures,  not  at  all  unlike  auricular 
fibrillation  of  the  heart. 

Since  the  colon  is  a reservoir  for  effete,  indi- 
gestible, and  undigested  food,  and  millions  of 
bacteria,  both  pathogenic  and  non-pathogenic, 
nature  has  provided  this  structure  with  a glisten- 
ing, paraffin-like  covering  in  its  ability  to  se- 
crete mucous.  This  mucous  not  only  protects  this 
sensitive  membrane  from  the  scratching  and  irri- 
tation by  the  fecal  mass,  but,  in  a way,  inhibits 
undue  absorption. 

Modern  civilization  has  become  addicted  to 
daily  purgative  pills.  This  is  due  to  widespread 
advertisements  both  to  the  doctor  and  laity,  of 
the  various  and  sundry  spas,  and  the  general  use 
of  aperient  waters.  It  has  also  been  aided  by 
the  change  in  habits  and  type  of  foods,  the  mod- 
ern mode  of  living,  and  above  all,  the  lack  of 
time  necessary  for  proper  evacuation. 

After  the  constant  use  of  purgatives,  over  a 
long  period  of  time,  either  chemically  or  me- 
chanically, or  by  the  routine  use  of  roughage, 
such  as  bran,  the  patient  soon  irritates  the  colon 
to  a point  of  definite  spasm  or  fibrillation,  not 
unlike  that  produced  in  the  heart  by  digitalis, 


or  toxemia.  The  natural  gastro-colic  reflex  is 
gone,  and  a condition  develops  termed  by  Hurst 
as  a Dyschezia.  This  condition  is  an  inability  to 
evacuate  the  bowel  content,  even  though  the 
stool  is  in  the  rectum.  This  is  one  of  the  most 
common  causes  of  the  enema  habit. 

This  constant  irritation  of  the  gastro-intestinal 
tract  with  artificial  stimulants  over  a long  period 
of  time,  causes  the  colon  contents  to  be  continu- 
ally liquid.  The  colon  is  not  prepared  to  be  a 
reservoir  for  liquid  materials.  The  mucosa  be- 
comes irritated,  peristalsis  occurs  in  the  descend- 
ing colon,  which  is  entirely  foreign  to  a normal 
descending  colon.  It  then  develops  a capacity 
to  absorb  toxic  materials  now  greater  than  that 
of  a non-irritated  colon.  Abnormal  changes  in 
gas  absorption  occur.  Non-pathogenic  bacteria 
quite  often  become  pathogenic.  Toxins  are  be- 
ing absorbed  in  overwhelming  doses. 

To  be  sure,  the  purgative  habit  must  be  con- 
tinued, and  a condition  develops,  properly  de- 
scribed years  ago,  as  intestinal  "auto-intoxica- 
tion." This  toxic  material,  and  its  various  and 
sundry  poisons,  must  be  carried  by  the  lymph 
stream  and  portal  system.  Certainly  the  liver 
has  plenty  of  work,  besides  taking  care  of  the 
job  it  has  not  "bargained  for."  The  detoxifying 
power  of  the  liver  is  soon  used  up.  There  de- 
velops an  hepatic  insufficiency  with  interference 
with  glycogen  function  of  the  liver.  This  con- 
stant assault  with  purgatives  from  above,  and 
enemas  and  colonic  irrigations  from  below,  soon 
causes  the  colon  to  revolt. 

A true  "guerilla  warfare"  follows.  The  colon 
begins  to  pour  off  large  quantities  of  mucous, 
in  an  attempt  to  protect  its  delicate  lining  from 
these  noxious  poisons.  The  pylorus  goes  into 
spasm,  and  the  ileo-cecal  valve  becomes  hyper- 
tonic, with  resulting  violent  spasm  of  the  recto- 
sigmoid. So,  you  see,  the  entire  mechanism  of 
the  digestive  tract  is  upset  with  resultant  violent 
pains  in  the  epigastrium,  left  or  right  flank,  re- 
verse peristalsis,  with  nausea  and  vomiting,  and 
severe  pain  after  the  ingestion  of  food  in  an 
attempt  to  initiate  the  normal  gastro-colic  re- 
flex. 

The  patient,  not  understanding  this  condition, 
seeking  the  advice  of  doctor  or  friend,  probably 
of  his  own  accord,  is  led  to  believe  that  certain 
foods  are  causing  this  condition,  and  in  due  time 
develops  an  idiosyncrasy  to  various  foods.  By 
the  elimination  of  certain  foods,  such  as  milk, 
fruits  and  vegetables,  etc.,  they  are  finally  down 
to  one  or  two  foods,  and  soon  develop  a true 
vitamin  deficiency.  This  manifests  itself  in  loss 


February,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


145 


of  weight,  dyspepsia,  violent  headaches,  nausea 
and  vomiting,  migraine,  diarrhea,  alkalosis,  or 
acidosis. 

They  consult  various  advisors,  get  various  opin- 
ions, and  have  innumerable  surgical  assaults  to 
the  abdomen,  namely:  appendectomy,  cholecy- 
stectomy, ileostomy,  gastro-enterostomy,  and 
pexys.  Ovaries  and  tubes  are  removed,  various 
radical  operations  on  the  para-nasal  structures 
are  done,  and  ventriculograms  are  made.  They 
follow  numerous  ideas  and  diets,  and  soon  be- 
come somatic  neurotics,  and  develop  sitophobia 
(a  morbid  or  insane  dread  of  eating).  These  pa- 
tients give  up  hope,  become  apprehensive  and 
irritable,  and  the  condition  so  commonly  called 
hypochondriasis,  or  neurasthenia  ensues.  As 
Omar  Khayam  says,  "He  leaves,  not  knowing 
whence  he  came." 

In  due  time  most  of  them  are  convinced  that 
they  are  disabled,  physically,  and  probably  fi- 
nancially. We  are  now  dealing  with  a definite 
neurotic  individual,  who  is  apprehensive,  wanting 
a quick  cure  for  this  syndrome  which  has  taken 
months,  or  years  to  develop.  His  cathartic  habit 
is  as  well  developed  as  an  addict  to  morphia. 
He  states  that  if  he  does  not  have  a cathartic 
he  will  die.  Truly,  a pitiful  state  of  affairs.  Cer- 
tainly he  cannot  be  cured  in  one  day  or  one 
month.  These  patients  soon  become  unable  to 
work,  their  home  surroundings  are  changing,  and 
their  mental  depressions  are  at  times  marked  to 
the  degree  of  suicide.  By  this  time  the  picture 
has  changed;  we  not  only  have  a neurosis,  but 
a vitamin  deficinecy,  avitaminosis  with  its  va- 
rious pathological  complications. 

It  is  an  accepted  fact  that  the  patients  who 
develop  this  syndrome  come  under  the  heading 
of  constitutional  inferiority,  so  far  as  the  nerve 
mechanism  of  their  gastro-intestinal  tract  is  con- 
cerned. They  belong  to  the  triad  of  hayfever, 
eczema  and  migraine.  A majority  of  them  are 
allergic,  and  about  5 per  cent  of  these  patients, 
in  my  observation,  show  definite  allergic  reac- 
tions to  foods.  Urticaria  is  a frequent  observa- 
tion. Endocrine  disturbances,  hypo-  and  hyper- 
thyroidism, occur  in  at  least  10  per  cent.  Dys- 
menorrhea occurs  in  20  per  cent  of  the  females. 
Impotency  occurs  in  at  least  5 per  cent  of  the 
males.  They  are  chronic  sinus  sufferers  and  have 
no  power  of  immunity  insofar  as  their  sinuses  are 
concerned.  Vasomotor-rhinitis  and  pharyngitis 
are  most  common  symptoms.  Ureteral  spasm, 
neuralgias,  myalgias,  and  neuritis  are  common. 
One  of  the  most  common  conditions  is  the  uni- 
lateral headche  (so-called  migraine),  which  oc- 


curs in  the  great  majority  of  cases,  and  for  which 
attempts  at  operation  have  been  done  on  the 
paranasal  sinuses,  with  discouraging  effects  to 
the  patient. 

So,  you  see,  we  are  dealing  with  a condition 
that  occurs  in  practically  all  types  of  people, 
especially  the  highly  sensitive  type,  the  emotional 
type,  and  those  with  a neurogenic  background. 
In  other  words,  the  hyperaesthetic  individual; 
the  musician,  artist,  student,  professional  man 
and  woman,  and  those  who  come  from  families 
of  hayfever,  migraine  and  allergy.  The  negro 
is  peculiarly  immune,  but  it  has  been  my  ob- 
servation in  other  races  that  it  is  as  common  in 
one  as  the  other.  Women  are  affected  more 
often  than  men.  The  condition  occurs  in  every 
age,  children  as  young  as  8 to  10  years,  and 
adults  as  old  as  70. 

For  clinical  purposes  we  divided  the  irritable 
colon  into  three  types:  First,  the  mild  type;  sec- 
ond, the  moderately  severe  type,  and  third,  the 
severe  type. 

The  mild  type. — This  type  has  various  special- 
ists treating  various  portions  of  the  body,  is  ad- 
dicted to  enemas  and  purgatives,  has  periodic 
headaches,  takes  barbitals  at  night  to  sleep,  car- 
ries along  fairly  well,  gaining  and  losing  weight, 
is  a frequent  visitor  to  the  various  spas,  springs 
and  dietetic  institutions,  uses  various  dietetic 
foods;  in  fact,  makes  a life  study  of  foods,  is  a 
constant  observer  of  stools,  becoming  "hipped" 
on  this  subject.  This  is  the  type  that  makes  up 
the  bulk  of  the  clientele  in  the  various  general 
clinics. 

The  common  symptom  is  constipation,  stools 
are  unsatisfactory  to  the  patient,  infrequent  and 
difficult  to  evacuate,  small  in  caliber,  sometimes 
flat  in  contour  and  other  times  resembling  sheep 
dung  stools.  The  common  statement  is  that  the 
cathartics  have  failed  to  give  relief,  and  so  the 
patient  comes  to  the  physician. 

He  has  abdominal  consciousness  and  burning 
of  the  abdomen,  gaseous  distention,  various  and 
sundry  irregular  pains.  He  has  become  retro- 
spective, analytic,  and  his  entire  interest  centers 
on  his  abdomen.  Again,  abdominal  distress  oc- 
curs with  pain  up  to  the  point  of  acute  paroxyms, 
and  a dull  aching  of  the  abdomen,  generalized, 
or  localized  in  the  region  of  the  pylorus,  and 
quite  often  referred  to  the  left  shoulder  as  in 
gall  bladder  disease.  The  epigastric  distress  is 
quite  similar  to  the  distress  of  peptic  ulcer,  but 
it  does  not  occur  at  definite  periods,  neither  is 
the  pain  over  finger  point  area.  It  is  variable 
in  its  appearance,  and  may  occur  after  some 


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[Vol.  XXXI,  No.  9 


meals,  and  not  after  others;  after  some  foods, 
but  not  after  others;  on  some  days  and  not  on 
others.  It  is  not  periodic,  and  never  does  it 
awaken  a patient  at  night. 

Pain  in  the  ileocecal  region  occurs  in  over  70 
per  cent  of  my  patients,  although  statistics  of 
other  men  are  different.  Jordon  and  Keifer  re- 
port that  25  per  cent  of  their  patients  with 
irritable  colon  had  their  appendices  removed. 
Eggleston  states  that  22  per  cent  of  his  patients 
had  their  appendices  removed.  There  are,  un- 
doubtedly, instances  where  differential  diagnosis 
between  appendicitis,  and  disorders  of  the  colon 
are  difficult,  and  even  after  observation  a laporo- 
tomy  may  be  justified.  But,  as  Bettman  says, 
"Where  appendectomy  is  performed  on  the  pa- 
tient when  diagnosis  is  based  on  nothing  more 
than  indigestion,  and  a poke  in  the  right  iliac 
region,  it  is  no  wonder  that  the  series  is  so  high." 

The  diagnosis  of  irritable  colon  of  the  mild 
type  is  made  by  history,  complete  physical,  and 
thorough  proctoscopic  and  sigmoidoscopic  ex- 
aminations, with  most  careful  study  of  the  stools. 
X-ray  examination  is  very  important,  and  must 
be  complete  of  the  entire  gastro-intestinal  tract 
with  a barium  enema.  X-ray  examination  re- 
veals either  a general  spasticity  of  the  entire 
colon  or  of  segmented  portions  of  it.  Usually 
the  distal  colon  is  involved,  and  in  some  cases  the 
haustral  markings  are  lost,  and  the  colon  presents 
a "shoe-string"  appearance.  Delayed  emptying 
time  of  the  colon  is  common  with  incontinence 
of  the  ileo-cecal  valve,  and  the  cecum  may  be 
dilated  with  associated  pylorospasm. 

On  physical  examination  we  find  the  colon 
tender  and  hard,  and  if  the  patient  is  thin,  con- 
tractions in  the  colon  are  easily  felt.  Examina- 
tions of  the  stools  show  them  diminished  in  cali- 
ber, covered  with  mucous  and  in  this  type  fre- 
quent examinations  of  the  stools  will  find  them 
negative  for  infestation. 

Just  here,  let  me  state  that  I think  one  of  the 
most  valuable  instruments  we  have  in  our  diag- 
nostic armamentarium  is  the  protoscope,  and 
still  it  is  rarely  used  except  by  surgeons  who  are 
especially  interested  in  diseases  of  the  rectum. 
In  my  opinion,  every  physician  and  practitioner 
should  familiarize  himself  with  the  proctoscope. 
It  is  not  expensive  and  with  a little  practice  it 
can  be  used  in  the  bowel  with  perfect  safety 
without  the  use  of  anesthetic,  and  without  any 
considerable  degree  of  discomfort  on  the  part  of 
the  patient.  I think  that  it  is  no  more  justifiable 
to  treat  the  colon  for  its  various  diseases  with- 
out inspecting  the  membranes  of  the  colon  that 


it  would  be  to  treat  a sore  throat  without  look- 
ing into  the  throat. 

Second — the  moderately  severe  type.  Here, 
the  patient  has  all  symptoms  of  an  irritated  colon 
in  an  aggravated  form,  flatulence  and  gaseous 
distress  with  absorption  of  absorbable  gases.  We 
must  not  forget  that  gases  are  normally  liber- 
ated in  the  colon.  These  gases  include  carbon 
dioxide,  hydrogen,  nitrogen,  methane,  and  hy- 
drogen sulphide.  Nitrogen,  hydrogen,  and  hy- 
drogen sulphide  are  passed  through  the  rectum 
daily,  while  large  amounts  are  absorbed  into 
the  blood  and  so  eliminated  from  the  respira- 
tory tract. 

In  normal  metabolism,  a person  is  little  dis- 
tressed by  the  passage  of  gases  with  increased 
formation  of  gas.  When  excretion  is  impaired, 
the  patient  experiences  abdominal  consciousness 
and  later  abdominal  distress.  A spastic  colon 
interefres  with  elimination  of  gas  in  two  ways. 
First,  by  spasticity,  it  diminishes  the  lumen  of 
the  gut  and  so  reduces  the  amount  of  available 
absorbent  surface  for  the  gases.  Second,  a 
spastic  colon  produces  stasis,  and  retained  fecal 
masses  occupying  space  within  the  lumen  of  the 
gut  further  diminishes  the  available  surface  for 
absorption  of  gases. 

At  this  stage  the  patient  begins  to  lose  weight, 
is  apprehensive,  nauseated,  vomits  an  occasional 
meal,  develops  a profound  insomnia,  mental  de- 
pression and  psychoneurosis.  Quite  frequently 
at  this  stage  there  are  bladder  symptoms  with 
ureterospasm,  retention  of  urine,  paroxysmal 
tachycardia,  precordial  pain,  quite  similar  to 
angina,  with  usually  an  irregular  temperature.  A 
symptom  complex  of  neuro-circulatory  asthenia 
with  sweating  palms,  tachycardia,  tremor,  hot 
and  cold  flashes,  vertigo,  spots  before  the  eyes 
and  tinnitus  aurium  are  present.  Attacks  of  ab- 
dominal distress  soon  occur  more  often,  the  pa- 
tient refuses  to  eat,  or  develops  Osier's  symp- 
tom complex,  anorexia  nervosa. 

In  this  stage  erythematoses  are  common,  also 
eczema  and  various  and  sundry  skin  lesions.  The 
patient  takes  on  a sallow  color  or  dusky  hue. 
The  picture  at  this  stage  can  resemble  various 
and  sundry  diseases  as  pellagra,  pernicious  ane- 
mia, carcinoma,  sprue,  miliary  tuberculosis,  or 
what  not. 

Third — the  severe  type.  This  type  is  the  hos- 
pital type.  The  patient  is  usually  brought  in 
with  acidosis  or  alkalosis,  marked  dehydration 
and  evidence  of  avitaminosis.  The  skin  is  dry 
and  exudative.  The  eyes  are  sunken.  Tongue 
red.  He  is  unable  to  take  nourishment,  neces- 


February,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


147 


sitating  feeding  by  Levin  tube,  hyperdermocly- 
sis  and  drastic  stimulation. 

The  patient  may  have  hyperemesis  or  diarrhea 
in  the  extreme,  and  convulsions  are  not  at  all 
uncommon.  At  this  stage  pyrexia  is  the  rule  and 
not  the  exception,  and  it  is  here  that  we  get  the 
so-called  gut  leukocytosis  where  the  leukocyte 
count  may  run  from  thirty  to  forty  thousand. 
Suppression  of  urine  occurs  and  only  the  most 
drastic  procedures  can  save  the  patient's  life, 
such  as  blood  transfusions  and  intravenous  use 
of  glucose,  or  the  use  of  hypertonic  solutions 
of  sodium  chloride  where  alkalosis  exists. 

Not  infrequently  the  patient  falls  into  the 
hands  of  the  surgeon  between  the  second  and 
third  stage,  or  during  the  third  stage.  This  is 
truly  hazardous  to  the  patient,  unless  the  sur- 
geon is  quite  familiar  with  this  condition  and 
can  diagnose  it.  He  has  an  even  break  with 
surgery  during  the  first  stage  for  at  this  time  his 
resistance  is  not  low,  and  he  can  probably  with- 
stand the  various  assaults  or  insults  to  his  abdo- 
men. 

In  the  third  stage  he  is  a very  bad  risk  for  the 
surgeon.  Truly  a hair-splitting  diagnosis  is  de- 
manded when  a patient  is  brought  to  the  hos- 
pital in  an  ambulance  with  a history  of  acute 
onset  of  pain,  nausea  and  vomiting,  board-like 
fixation  of  the  abdomen,  plus  leukocytosis  and 
fever.  But,  with  a previous  history  of  spastic 
colon  and  passage  of  large  quantities  of  mucous 
in  stools,  careful  examination  of  such  a patient 
will  reveal  that  fixation  is  not  constant,  that 
pressure  on  the  abdomen  relieves  the  pain  rather 
than  aggravates  it,  that  the  abdomen  is  not 
silent,  as  one  gets  with  perforated  viscus.  That 
is,  the  gases  in  the  abdomen  are  carried  through 
the  tubing  normally,  which  is  not  found  in  per- 
foration where  the  abdomen  is  silent.  The  peri- 
toneal reflex  does  not  cause  pain,  and  a close 
study  of  the  blood  will  show  a relative  eosino- 
philia  and  large  doses  of  atropine  will  relax  the 
patient. 

TREATMENT 

In  considering  the  treatment  of  irritable  colon, 
the  following  points  must  be  considered: 

The  patient  has  been  in  a state  of  hyper- 
excitability and  is  unable  to  relax.  This  is  a 
state  of  hypertonicity  of  the  colon  that  can  be 
initiated  within  the  lumen  of  the  colon,  from 
elsewhere  in  the  body  or  from  emotions.  Be- 
cause of  the  large  number  of  patients  affected 
with  this  condition,  many  treatments  have  been 
inaugurated.  Although  in  the  first  and  second 


stage  this  malady  is  not  dangerous  to  life,  it  is 
responsible  for  much  misery  and  invalidism.  In 
a majority  of  the  cases  the  response  to  treat- 
ment is  gratifying.  The  therapeutic  efforts  should 
be  directed  to  the  particular  individual,  and  not 
to  the  syndrome  of  irritable  colon. 

A most  thorough  history  and  complete  physi- 
cal examination,  including  a most  thorough  gas- 
trointestinal series,  and  study  of  the  colon  by 
barium  enema  is  necessary.  An  essentially  neg- 
ative examination  outside  of  irritable  colon  car- 
ries great  value  and  therapeusis.  It  is  the  founda' 
tion  for  the  intelligent  co-operation  of  the  pa- 
tient. His  confidence  is  restored,  due  to  his  in- 
sight into  the  true  basis  of  his  condition. 

The  next  important  step  is  the  diet.  The  diet 
should  be  individual.  The  types  that  are  con- 
stipated, with  the  passage  of  large  quantities  of 
mucous,  should  receive  a bland,  smooth,  diet, 
which  is  high  in  vitamins,  has  a minimum  amount 
of  roughage,  and  a very  little  cellulose  or  or- 
ganic acids.  The  first  vegetables  and  fruits 
should  be  pureed.  If  the  patient  can  tolerate 
milk,  it  should  be  given,  and  the  various  milk 
preparations,  pureed  fruits,  pot  liquor,  cocoa, 
cottage  cheese,  sherbet,  rice,  farina,  mashed  po- 
tatoes, custard,  and  jell-o  in  feedings  every  two 
hours.  In  the  mild  cases  small  amounts  of  rough- 
age,  cooked  vegetables,  cooked  fruits,  Carrots, 
asparagus  tips,  butter,  peas,  baked  apple,  canned 
peaches  and  pears  are  then  added.  Uncooked 
fruit  and  vegetables  may  be  added  about  the 
third  or  fourth  week,  and  the  bulk  of  the  diet 
at  this  time  should  be  meat,  chicken,  fish,  eggs, 
junket,  cooked  cereals,  cottage  cheese,  fruit 
juices,  malt,  cod-liver  oil  and  yeast.  Sugar  should 
be  given  very  guardedly  and  throughout  the 
treatment  the  patient  should  abstain  from  con- 
diments, alcohol,  fermented  foods,  shell  fish, 
sausage  and  pork. 

It  is  necessary  at  all  times  to  continue  on  a 
high  vitamin  diet. 

MEDICATION 

The  sedatives  and  antispasmodics  play  an  im- 
portant role  in  the  treatment.  Atropine  and 
belladonna  are  the  most  important  antispasmod- 
ics. Bellandonna  is  most  commonly  used  for  re- 
lief of  intestinal  spasm.  Most  patients  tolerate 
it  very  well,  and  can  take  it  over  a long  period 
of  time.  Start  with  5 minims  three  times  a day, 
and  increase  to  as  high  as  30  minims  three  times 
a day  until  physiological  action  is  obtained.  Then 
the  drug  can  be  discontinued  for  a while  and 
later  given  at  various  irregular  intervals. 


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[Vol.  XXXI,  No.  9 


For  the  past  eight  months  a most  satisfac- 
tory substitute  for  atropine  has  been  found  in 
a new  preparation  called  novatropine.  It  is  a 
non-toxic  form  of  atropine  with  all  of  its  ther- 
apeutic qualities  and  practically  none  of  its 
drawbacks.  Chemically,  novatropine  is  methyl- 
homatropinebromide.  Its  effect  as  an  antispas- 
modic  is  comparable  to  that  of  atropine  and  8 
to  10  times  as  potent  as  homatropine.  It  is  less 
than  one-thirtieth  as  toxic  as  atropine,  making 
it  a most  ideal  drug  for  the  treatment  for  irri- 
table colon.  The  dose  is  I /24  of  a grain,  two 
or  three  times  a day  before  meals. 

Of  the  sedatives,  bromides  and  the  barbitals 
are  the  most  common.  Sedatives  should  be 
given  in  conjunction  with  belladonna  on  account 
of  the  initial  stimulating  action  of  belladonna  on 
the  nervous  system.  The  sedatives  relax  the  pa- 
tient, and  have  a hypnotic  effect  on  the  central 
nervous  system.  Local  applications  of  diather- 
my give  considerable  relief.  The  local  applica- 
tion of  heat  to  the  abdomen  in  the  form  of  hy- 
droptherapy  has  a distinct  place  in  the  treat- 
ment of  these  cases.  Warm  baths  and  mild 
massage,  but  the  avoidance  of  undue  abdominal 
stimulation  are  important.  Colonic  irrigations 
with  large  quantities  of  fluid  are  mentioned  only 
to  be  condemned. 

If,  after  thorough  observation,  the  spasm  is 
limited  to  the  distal  colon,  especially  in  the  re- 
gion of  the  recto-sigmoid,  a method  first  ad- 
vocated by  Soper  is  especially  indicated.  The 
proctoscope  is  carefully  passed  very  slowly  be- 
yond the  spasm,  leaving  the  scope  in  for  ten  to 
fifteen  minutes,  and  in  this  way  dilating  the  spas- 
modic area  and  exhausting  the  recto-signoid.  A 
colon  tube  is  then  passed  through  the  tunnel  of 
the  scope,  and  the  scope  is  withdrawn,  and  60 
ccs.  of  a 30  per  cent  solution  of  magnesium  sul- 
phate is  poured  into  the  colon  by  means  of  a 
funnel.  The  patient  continues  in  knee-chest  po- 
sition for  ten  more  minutes,  and  200  ccs.  of  equal 
parts  of  Wesson  Oil  and  warm  castor  oil  is 
poured  through  the  funnel.  The  patient  is  in- 
structed to  retain  this  as  long  as  possible. 

The  magnesium  sulphate  causes  relaxation  of 
the  sphincter,  the  Wesson  Oil  is  for  lubrication, 
and  the  castor  oil  combined  with  the  sodium 
salts  produce  a sodium  ricinolate,  which  is  an 
antiseptic  and  will  play  a part  in  the  combating 
of  secondary  infections  which  quite  often  occur. 
This  treatment  is  repeated  every  three  or  four 
days  for  about  two  weeks,  and  then  once  a week 
for  two  months.  In  the  meantime  the  patient  is 
allowed  occasional  salt  water  enemas,  or  an 


olive  oil  enema  twice  a week.  Plain  mineral  oil 
at  night  is  beneficial.  In  the  cases  where  there 
are  frequent  loose  stools,  calcium  gluconate,  bis- 
muth subcarbonate  and  dihydronal  are  of  bene- 
fit. Charcoal  is  given  for  gas  distention  and 
dyspepsia.  We  have  found  that  the  giving  of 
castor  oil  once  every  ten  days,  or  two  weeks,  has 
been  very  beneficial  in  the  cases  who  have  loose 
stools  containing  a large  quantity  of  mucous. 

Throughout  the  treatment  the  physician  must 
attempt  psychotherapy  and  re-education  of  the 
patient.  His  habits  should  be  studied  and  his 
environmental  conditions  should  be  investigated. 
The  physician  should  gain  the  confidence  of  the 
patient,  and  when  it  is  won,  suggestion  can  be 
used  to  change  the  patient's  attitude  toward 
life  and  to  withdraw  his  attention  from  his  bodily 
functions.  This  cannot  be  done  with  one  sitting, 
but  with  various  sittings.  He  must  be  made  to 
understand  that  he  has  no  serious  organic  dis- 
ease, and  that  his  condition  is  only  functional, 
and  the  cure  can  only  be  accomplished  by  his 
own  efforts,  and  co-operation. 

In  conclusion,  (I)  Irritable  colon  is  a functional 
disturbance  of  the  colon. 

(2)  It  occurs  more  often  in  women  than  in  men, 
especially  the  neurotic  type. 

(3)  It  is  not  a disease  entity. 

(4)  It  is  not  an  inflammatory  condition  of  the 
colon. 

(5)  It  occurs  in  highly  sensitized  individuals. 

(6)  It  is  a functional  condition  which  in  time 
may  produce  grave  symptomatology. 

(7)  This  condition  in  general  cannot  be  treated 
by  drugs,  prolonged  irrigations,  various  and  sun- 
dry treatments.  The  only  drug  of  absolute  value 
is  belladonna. 

(8)  Dysfunction  calls  forth  a physician  as  a 
therapeutist,  psychoanalyst  and  psychotherapist. 

(9)  Diet  plays  an  important  part  in  the  cause 
and  treatment. 

(10)  Definite  and  absolute  factors  that  tend  to 
accentuate  this  condition  should  be  removed. 

1108  Madison  Avenue. 


PANEL  SYSTEM  IN  ENGLAND 

Doctors  who  participate  in  the  panel  system  in  Eng- 
land are  paid  $2.25  a year  for  each  insured  person  on 
their  list,  and  for  that  sum  make  as  many  sick  calls  as  are 
required  during  the  year.  The  average  number  of  insured 
persons  on  a physician's  list  is  about  1,000." — N.  Y. 
State  J.  M. 


February,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


149 


CHIASMAL  SYNDROME 
REPORT  OF  CASES.  * 

ALBERT  H.  MANN,  M.  D.,  Texarkana 


Advances  made  in  neurological  diagnosis 
in  the  past  few  years  have  brought  to  our  at- 
tention a small  group  of  cases  in  which  symptoms 
have  been  caused  by  a suprasellar  lesion.  These 
have  been  described  by  Cushing  as  the  Chias- 
mal Syndrome.  They  gain  their  importance,  not 
from  their  frequency,  but  from  fhe  serious  ef- 
fects on  vision  and  life,  the  avoidance  of  which 
demands  prompt  recognition.  Naturally  the  op- 
thalmologist  is  the  first  to  be  consulted,  and  as 
a rule  a diagnosis  of  retrobulbar  neuritis  is  made, 
until  with  the  persistence  of  symptoms  a neurolo- 
gical consultation  is  sought  and  the  true  nature 
of  the  condition  becomes  apparent. 

Briefly  stated  the  syndrome  consists  of  pri- 
mary optic  atrophy  and  bitemporal  field  defects 
with  an  essentially  normal  sella.  It  may  be  pro- 
duced by  a variety  of  pathological  changes  in 
the  region  of  the  chiasm.  The  lesions  that  have 
been  found  responsible  are: 

\ 

1.  Meningiomas,  having  their  origin  over  the 
chiasmal  sulcus  and  tuberculum  sella.  These  are 
the  most  frequent  and  the  most  favorable  for 
operation.  They  generally  occur  in  adults.  Cal- 
cification is  rare. 

2.  Pituitary  Adenomas,  these  without  defor- 
mity of  the  sella  are  rare. 

3.  Congenital  Tumors,  these  arise  from  the 
cranio-pharyngeal  pouch.  Symptoms  may  occur 
at  any  age.  Calcification  is  generally  present. 
The  prognosis  is  poor. 

4.  Gliomas,  arising  from  the  optic  chiasm  or 
third  ventricle.  These  may  spread  forward  as 
far  as  the  retinal  end  of  the  optic  nerve.  This 
is  often  found  associated  with  von  Reckling- 
hausen's disease,  and  is  generally  seen  in  chil- 
dren. 

5.  Chronic  Local  Arachnoiditis. 

6.  Syphilitic  Meningitis. 

7.  Aneurysm. 

The  following  cases  were  seen  during  the  past 
year  and  illustrate  the  diagnostic  and  therapeutic 
difficulties  encountered: 

Case  I.  W.  J.,  aged  fifteen,  was  first  seen  April  12, 
1933,  complaining  of  blurring  vision  in  the  left  eye  for 
as  long  as  he  could  remember  and  occasional  attacks 

* Read  before  the  Fifty-ninth  annual  session  of  the 
Arkansas  Medical  Society  held  in  Little  Rock,  April  16- 
18,  1934. 


of  blurring  of  vision  in  the  right  eye.  Frontal  headaches 
have  frequently  been  present  for  the  past  two  years. 
Nystagmus  has  been  present  for  two  months.  Left  optic 
atrophy  was  discovered  six  to  eight  years  ago.  In  1926 
there  was  a cardiac  disturbance  which  was  followed  by 
a long  period  of  rest. 

The  ride  in  the  elevator  coming  to  the  office  excited 
an  attack  of  nausea,  vomiting  and  unsteadiness  of  gait 
although  he  could  walk  without  assistance.  Vertical 
nystagmus  with  a rotatory  component  was  present.  The 
left  pupil  was  larger  than  the  right.  Both  reacted  to 
light.  Vision  in  the  right  eye  was  20/24  and  in  the  left 
eye  was  light  perception.  There  was  a primary  optic 
atrophy  of  the  left  eye  and  a temporal  pallor  of  the 
right.  The  right  eye  showed  a temporal  hemianopsia. 
X-Ray  examination  showed  a normal  size  sella.  There  wad 
apparently  an  undermining  of  the  anterior  clinoids.  Blood 
Wassermann  was  two  plus.  The  impression  was  that  we 
were  dealing  with  a pituitary  tumor  or  one  in  that  regions 
and  he  was  referred  to  a neuro-surgeon. 

Doctor  M.  M.  Peet  of  Ann  Arbor  was  consulted  and 
operated.  His  findings  are  as  follows:  "At  operation 
the  tumor  was  found  to  arise  from  the  left  optic  nerve. 
The  tumor  involved  the  entire  left  optic  nerve  forward 
to  about  one  and  one-half  or  two  mm.  from  the  optic 
foramen.  From  this  point  backwards  it  rapidly  en- 
larged, reaching  a size  about  equal  to  my  two  thumbs. 
It  was  grayish  in  color,  and  had  a thin  capsule.  The 
tumor  extended  forward  on  to  the  bone  in  the  midline 
and  laterally  along  the  cribriform  plate.  It  completely  re- 
placed the  chiasm,  but  grossly  did  not  infiltrate  the  right 
optic  nerve,  which  was  displaced  to  the  right.  The  nerve 
was  divided  close  to  the  optic  foramen  and  a large  lobe 
of  the  tumor  passing  anteriorly  was  removed  in  one 
piece.  That  over  the  sella  turcica  was  removed  in  nu- 
merous pieces.  The  chiasm  was  divided  close  to  the  right 
optic  nerve.  The  tumor  extended  on  to  the  floor  of  the 
third  ventricle,  and  it  was  impossible  to  say  whether  we 
had  removed  all  of  it  or  not.  Both  third  nerves  were' 
seen  during  the  operation.  The  left  one  had  been 

stretched  laterally,  and  the  right  one  was  displaced." 
Death  occurred  the  following  day.  Autopsy  showed  that 
the  tumor  had  infiltrated  the  optic  tract,  and  from  there 
had  extended  across  involving  the  entire  floor  of  the 
third  ventricle  back  to  the  mammillary  bodies.  An  in- 
teresting finding  was  an  acute  perforation  at  the  lower 
end  of  the  esophagus  with  stomach  contents  in  the  left1 
pleural  cavity.  An  acute  peptic  ulcer  of  the  stomach 
was  also  found. 

Case  2.  M.  P.,  aged  fifteen,  was  seen  September  20, 
1933,  complaining  of  sudden  loss  of  vision  first  noticed 
about  two  weeks  ago  when  he  found  he  could  not  recog- 
nize the  figures  on  playing  cards.  He  had  been  ex- 
amined on  several  occasions  for  visual  disturbances,  first 
eight  years  ago.  At  no  time  was  his  vision  found  to  be 
defective.  Two  years  ago  he  received  muscle  exercises. 
He  had  been  receiving  pituitary  medication  for  some 
months. 

The  patient  was  a somewhat  obese  boy.  He  was  bright 
and  cheerful.  Vision  in  the  right  eye  was  4/200  and  irt 
the  left  eye  20/100.  He  stated  that  he  could  see  only 
the  right  half  of  the  chart  with  his  right  eye.  The  right 
pupil  was  larger  than  the  left.  Both  reacted  to  light. 
Vision  was  not  improved  with  glasses.  The  fundi  were 
normal.  The  sella  showed  no  abnormality  on  X-ray  exam- 
ination. General  physical  examination  was  negative,  ex- 
cept for  obesity.  Visual  field  determination  September 
twenty-first  showed  a slight  temporal  contraction  of  the 


150 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  9 


field  of  both  eyes.  The  campimeter  studies  revealed 
a nasal  hemianopsia  of  the  right  eye  which  involved  the 
point  of  fixation  with  a defect  of  the  nasal  portion  of 
the  outer  lower  quadrant  of  the  field.  There  was  an  en- 
largement of  the  blind  spot  of  the  right  eye.  Consulta- 
tion was  advised  because  of  the  possibility  of  tumor,  but 
it  was  decided  to  treat  him  for  a time  to  see  if  im- 
provement would  not  occur.  He  was  consequently  treated 
as  a case  of  retrobulbar  neurtis.  Later  field  studies 
showed  a central  scotoma  of  the  right  eye  with  an  en- 
largement of  the  blind  spot  of  the  left  eye.  A slight 
papillitis  developed  in  the  left  eye  and  he  was  referred 
to  Doctor  Myer  Weiner  who  found  a bitemporal  hemian- 
opsia. He  was  seen  by  Doctor  Sachs  who  made  the 
diagnosis  of  Frohlich's  syndrome  in  the  presence  of  a 
suprasellar  tumor.  Operation  on  October  twenty-eighth 
revealed  a large  adenoma  of  the  pituitary  situated  above 
the  sella.  No  attempt  to  remove  the  tumor  was  made. 
Death  occurred  the  following  day. 

As  previously  stated  most  of  these  cases  have 
heretofore  been  diagnosed  as  retrobulbar  neu- 
ritis and  in  all  cases  where  this  diagnosis  is  made 
the  possibility  of  a localized  lesion  of  the  visual 
pathways  should  be  kept  in  mind. 

The  first  case  presented  the  rather  unusual 
complication  of  acute  perforation  of  the  upper 
gastro-intestinal  tract.  Cushing  in  his  series  of 
something  over  two  thousand  cases  has  had  three 
examples  of  this,  and  an  additional  eight  cases 
of  a more  chronic  lesion.  These  are  given  as 
examples  supporting  the  neurogenic  theory  of 
peptic  ulcer. 

The  second  case  is  interesting  from  the  diag- 
nostic point  of  view. 

DISCUSSION 

PAT  MURPHEY,  Little  Rock:  Dr.  Mann  asked  me  to 
discuss  his  paper,  and  I was  very  glad  to  do  it,  because 
I am  interested  in  the  subject  that  he  is  talking  about. 
Fortunately,  I happen  to  have  a couple  of  cases  at  this 
time  whom  I have  asked  to  come  here,  so  as  to  make 
the  lesions  that  he  is  describing  a little  bit  plainer.  In 
the  first  place,  these  lesions  are  neurological,  and  sooner 
or  later  those  patients  fall  into  the  hands  of  the  nerve 
specialists  and  neurological  surgeons.  The  majority  of 
them  first  go  to  see  the  eye  specialist  because  they  all 
complain  of  disturbances  in  seeing,  associated  with  a 
headache.  The  headache  is  usually  bi-temporal. 

The  little  girl,  you  see  here,  came  to  see  me  last  Sat- 
urday. She  is  thirteen  years  old.  She  can  not  see  any- 
thing out  of  the  left  eye,  except  that  she  can  tell  light 
from  darkness.  She  has  headaches  across  the  forehead 
and  in  the  temporal  regions.  There  is  an  inequality  of 
the  patellar  reflexes.  The  Wasserman  and  laboratory 
findings  are  entirely  negative.  Physically,  she  is  nof 
sick.  X-Ray  pictures  of  the  skull  show  no  bony  changes. 
If  there  is  any  difference  in  the  eye-ground  findings  from 
the  normal  condition,  it  seems  to  be  a beginning  of  pallor 
in  the  optic  disks.  I think  we  are  dealing  with  just  such 
a lesion  as  the  doctor  describes  but  in  the  earlier  stages. 

I have  told  her  mother  that  in  all  probability  in  a short 
time  that  it  would  be  necessary  to  operate  on  this  little 
patient  for  I think  we  are  dealing  with  a supra-sellar 
lesion. 


The  second  case,  this  young  man  came  to  the  hospital 
about  two  months  ago  complaining  of  a head  ache.  He 
had  a mental  condition  in  which  he  was  confused  and 
could  not  see  good.  He  complained  of  severe  head- 
aches. On  examination,  it  was  found  that  he  could 
not  see  out  of  his  left  eye,  except  on  the  nasal  side.  He 
had  changes  in  his  reflexes.  X-Ray  pictures  of  the  boy's 
skull  showed  bony  changes  in  the  region  of  the  sellar 
turcica.  Air  was  injected  into  the  posterior  horn  of  the 
lateral  ventricle  on  the  right  side,  and  further  X-Ray 
pictures  demonstrated  that  we  were  dealing  with  a tumor 
in  the  region  of  the  pituitary  body. 

When  you  get  a tumor  of  this  kind,  there  is  but  one 
treatment  and  that  is  to  attack  it  directly.  So  on  March 
4th,  this  boy  was  operated  on.  The  usual  frontal  flap 
was  made.  A big  cyst  was  found  and  was  drained.  This 
boy  has  improved  and  is  now  better  mentally  and  neurolo- 
gically  than  before  operation.  He  can  see  little  better, 
but  he  tells  me  that  a few  days  ago  for  about  an  hour 
or  a little  longer,  he  could  see  a great  deal  better  out 
of  this  eye  than  he  could  before  he  was  operated.  This 
case  shows  the  changes  and  findings  in  rather  an  ad- 
vanced case.  I believe  that  this  boy  will  still  get  better. 

I will  watch  the  little  girl  longer  before  surgery  is  un- 
dertaken. 

Dr.  Mann  has  covered  the  field  thoroughly,  and  has 
given  you  the  eye  findings  in  such  lesions,  and  these  two 
cases  bring  out  the  symptoms  that  Dr.  Mann  has  men- 
tioned in  his  paper. 

L.  H.  LANIER,  Texackana:  This  is  an  interesting  subject 
The  cases  reported  are  interesting.  Sometimes  I think 
all  patients  with  intracranial  pressure  should  be  immedi- 
ately referred  to  a pathologist,  and  he  should  consult  an 
internist,  roentgenologist,  and  neurologist. 

Visual  disturbances  resulting  from  affections  of  the 
chiasm  are  mostly  due  to  acromegaly,  tumor  of  the 
pituitary  body,  tubercle  and  syphilitic  gumma.  Temporal 
hemianopsia,  as  one  of  the  signs  of  chiasmal  involve- 
ment. may  be  found  to  result  from  trauma,  tumors,  tuber- 
culous exudations  or  granulations,  aneurysms,  pressure 
from  the  third  ventricle,  periostitis,  partial  meningitis, 
basilar  gummatous  meningitis  and  syphilitic  disease  of 
the  chiasm,  gummatous  arteritis,  hemorrhages  into  the 
chiasm,  multiple  sclerosis  and  the  hyperplasia  of  ele- 
phantiasis. 

Compression  of  tumor  on  the  chiasm,  tracts  and  optic 
nerves  vary  the  visual  field  defects  constantly. 

It  is  not  to  be  forgotten  that  in  basilar  cerebral 
syphilis  remarkable  fluctuations  of  the  field  may  also 
occur;  in  fact,  almost  any  field  changes  may  present 
themselves.  For  example,  complete  blindness,  changing 
during  restoration  into  temporal  hemianopsia,  nasal  limi- 
tation, irregular  field  defects,  all  of  which  arise  from 
tract  involvement,  as  well  as  from  chiasmal  disease. 

Sell  has  collected  more  than  60  cases  of  pressure  on 
the  chiasm  from  tumor  exudations  and  granulations  with 
no  visual  changes  manifest. 

Of  course,  glasses,  mydriatics,  muscle  imbalance  and 
the  loss  of  one  eye,  all  influence  the  field  of  vision  as 
well  as  the  time  in  the  course  of  the  disease. 

Lesions  of  the  chiasm  can  only  be  located  when  the 
field  changes  are  considered  in  connection  with  con- 
current symptoms. 

Many  field  changes  exist  which  may  be  easily  accounted 
for  by  evident  intraocular  disease,  as  pigmentary  retin- 
itis, disseminated  choroiditis,  retinal  detachment,  etc. 
These  field  changes  may  be  monocular  or  binocular,  and 


February,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


151 


in  the  case  of  retinal  detachment,  may  assume  forms 
not  unlike  altitudinal  hemianopsia. 

Many  cases  of  brain  tumor  do  not  come  to  attention 
until  the  taking  of  an  accurate  field  has  become  a very 
difficult  or  quite  impossible  matter.  As  is  well  known, 
the  generally  present  choked  disc  has  no  value  in-locali- 
zation in  these  cases,  nor  is  it  even  an  index  to  designate 
the  degree  of  involvement  of  the  brain  tissue.  In  a cer- 
tain percentage  of  cases  of  brain  tumor,  seen  early,  no 
changes  in  the  optic  nerve  are  to  be  found. 

Functional  nerve  diseases,  neurasthenia,  hysteria,  to- 
bacco and  alcohol,  sinus  involvement  and  various  systemic 
diseases  may  markedly  influence  the  visual  field. 

The  essayist  has  waded  far  out  into  the  open  sea.  I 
admire  his  courage  but,  like  the  sea,  the  problem  of  lo- 
calization and  the  causes  of  intra-cranial  pressure  shall 
'■emain  to  plague  and  confuse  us. 

DR.  MANN,  in  response:  I just  want  to  thank  Dr. 
Murphey  for  presenting  these  cases.  He  certainly  got 
better  results  than  I did  in  my  cases.  1 also  want  to 
thank  Dr.  Lanier  for  his  discussion. 

<8> 

CORRESPONDENCE 


Dr.  W.  R.  Brooksher, 

First  National  Bank  Bldg., 

Fort  Smith,  Ark. 

Dear  Doctor  Brooksher: 

It  is  the  hope  of  the  Cancer  Control  Committee  of  the 
Arkansas  Medical  Society  to  put  on  an  extensive  cancer 
control  program  this  year.  Will  you  please  call  to  the 
attention  of  the  county  societies  the  following  program 
which  we  hope  they  will  follow.  I have  already  written 
the  councilors  of  each  district  outlining  the  program. 

First,  the  General  Federation  of  Womens  Clubs  has 
adopted  for  this  year  a cancer  educational  program. 
This  was  brought  to  my  attention  by  the  American  So- 
ciety for  the  Control  of  Cancer.  It  is  the  idea  of  the 
committee  acting  through  the  councilor  of  each  district 
for  each  society  to  appoint  a cancer  control  chairman 
and  to  have  at  least  one  educational  program  on  can- 
cer as  soon  as  possible,  and  to  get  in  touch  with  the 
president  of  the  Federation  of  Womens  Clubs  of  their 
locality  and  offer  their  co-operation  in  putting  on  a 
program. 

I have  in  my  office  several  film  strips  on  cancer  con- 
trol, such  as  "Fighting  Cancer  With  Knowledge,"  etc.,  and 
also  another  film  on  cancer  of  the  breast,  to  be  shown 
to  the  medical  profession.  These  strips  I would  be  glad 
to  send  to  any  society  and  also  a projector  for  showing 
them.  The  educational  film  can  be  shown  to  any  lay 
group.  Of  course  the  local  program,  whether  they  have 
cancer  clinics  or  not,  will  be  left  entirely  with  the  local 
society. 

The  Cancer  Committee  will  be  glad  to  obtain  from 
the  American  Society  for  the  Control  of  Cancer  any 
iterature  to  be  distributed. 

Very  truly  yours, 

D.  W.  GOLDSTEIN,  Chairman, 
Cancer  Control  Committee, 
Arkansas  Medical  Society. 


RESOLUTION  BY  BOWIE-MILLER  COUNTY 
MEDICAL  SOCIETIES 


Whereas,  the  medical  profession  has  always,  does  now, 
and  will  continue  to  protect  and  promote  public  health 
by  safeguarding,  advancing,  and  administering  modern 
scientific  medicine;  and 

Whereas,  the  medical  profession  desires  the  safest  and 
best  relationship  between  the  patient  and  physician  to 
the  end  that  all  forms  of  unsafe  and  objectionable  social- 
ized medicine  may  be  abolished  or  defeated;  and 

Whereas,  there  is  a growing  tendency  on  the  part  of 
certain  foundations,  organized  charities,  governments, 
municipal,  state  and  federal,  to  hospitalize  and  treat  the 
sick;  and 

Whereas,  certain  organizations  have  far-reaching  cam- 
paigns that  all  school  children  be  tested,  immunized,  and 
examined  free,  regardless  of  the  ability  to  pay  for  this 
service;  and 

Whereas,  scientific  medicine  cannot  be  administered  en 
masse  with  accuracy  and  safety  to  the  patients; 

Therefore  be  it  Resolved:  (I)  That  we  condemn  the 
idea  of  governmental  or  lay  agencies  engaging  in  the 
practice  of  medicine  except  where  necessity  demands 
same,  such  as  the  army,  navy,  et  cetera; 

(2)  That  we  condemn  all  forms  of  socialized  medicine 
as  unsound  for  the  patient  and  harmful  to  the  advance- 
ment of  scientific  medicine; 

(3)  That  we  condemn  the  free  examination  of  school 
children  en  masse,  made  in  school  buildings,  as  unre- 
liable, unsafe  for  the  child,  and  unsound  in  principle  and 
practice. 

(4)  That  we  believe  for  the  welfare  and  health  of 
children,  all  examinations  should  be  made  in  the  office  of 
the  family  physician,  and  we  offer  this  as  the  most  sane 
and  sound  policy. 

(5)  That  we  pledge  ourselves  individually  and  as  an 
organization  to  make  such  examinations  and  to  institute 
such  measures  of  prevention  against  disease  as  are  prac- 
tical and  acceptable  to  the  parents,  for  reasonable  fees, 
or  under  such  terms  as  may  be  feasible  or  agreeable  to 
the  parents.  We  further  pledge  ourselves  to  see  that 
no  section  of  the  public  shall  be  neglected  because  of 
inability  to  pay. 

(6)  We  further  pledge  ourselves  to  take  no  part  in 
wholesale,  unscientific,  unsafe,  free  examinations,  or  whole- 
sale preventive  measures  applied  without  previous  indi- 
vidual study  of  children  to  determine  the  safety  of  such 
measures. 

$> 

HOSPITALIZATION  OF  THE  MENTALLY  ILL 

Members  of  the  House  of  Delegates  and  others  have 
been  solicited  by  Dr.  John  M.  Grimes  to  purchase  a book 
that  he  has  printed  purporting  to  contain  the  results  of 
the  study  recently  made  by  the  Council  on  Medical  Edu- 
cation and  Hospitals  of  the  hospitalization  of  the  men- 
tally ill  in  the  United  States.  Such  individual  use  of  the 
Council's  material  is,  of  course,  wholly  unauthorized.  A 
report  prepared  by  Dr.  Grimes  when  he  was  employed  by 
the  Association  was  not  published  because  in  the  opinion 
of  the  Council  and  an  advisory  committee  of  psychiatrists 
and  neurologists  his  conclusions  were  not  supported  by 
the  evidence  presented.  Two  partial  reports  that  have 
already  been  published  will  be  supplemented  when  fur- 
ther studies  have  been  completed. 

— J.  A.  M.  A.,  Nov.  10,  1934. 


152 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  9 


THE  JOURNAL 

OF  THE 

ARKANSAS  MEDICAL  SOCIETY 


Owned  by  the  Arkansas  Medical  Society  and  Published 
under  direction  of  the  Council 


DR.  W.  R.  BROOKSHER,  Editor 
610  First  National  Bank  Bldg.,  Fort  Smith,  Arkansas 


The  advertising  policy  of  this  Journal  is  governed  by  the  rules 
of  the  Council  on  Pharmacy  and  Chemistry  of  the  American 
Medical  Association. 

All  communications  to  this  Journal  must  be  made  to  it  exclu- 
sively. Communications  and  items  of  general  interest  to  the  pro- 
fession are  invited  from  all  over  the  State.  Notice  of  deaths, 
removals  from  the  State,  changes  of  location,  etc.,  are  requested. 


OFFICERS  OF  THE  ARKANSAS  MEDICAL  SOCIETY 


F.  O.  MAHONY,  President  El  Dorado 

M.  E.  McCASKILL,  President-Elect  Little  Rock 

A.  M.  ELTON,  First  Vice-President  Newport 

S.  C.  FULMER,  Second  Vice-President  Little  Rock 

F.  D.  SMITH,  Third  Vice-President  B lythevi He 

R.  J.  CALCOTE  Treasurer  Little  Rock 

W.  R.  BROOKSHER,  Secretary Fort  Smith 


COUNCILORS 

First  District — W.  M.  MAJORS 
Second  District — S.  J.  ALLBRIGHT  ... 

Third  District— M.  C.  JOHN  

Fourth  District— C.  W.  DIXON 

Fifth  District— L.  L.  PURIFOY 

Sixth  District— DON  SMITH 

Seventh  District — GEO.  B.  FLETCHER 

Eighth  District— S.  B.  HINKLE 
Ninth  District— D.  L.  OWENS 
Tenth  District— S.  J.  WOLFERMANN 


COMMITTEES 

(Appointments  expire  in  the  year  indicated.) 

Scientific  Work — L.  L.  Purifoy,  Chairman,  El  Dorado  (1935);  R. 
B.  Robins,  Camden  (1936);  W.  R.  Brooksher,  Fort  Smith  (1937). 

Medical  Legislation — Val  Parmlev,  Chairman,  Little  Rock 

(1937);  M.  L.  Norwood,  Lockesburg  (1937);  O.  L.  Williamson, 
Marianna  (1937);  H.  T.  Smith,  McGehee  (1936);  R.  L.  Smith, 
Russellville  (1936);  A.  S.  Buchanan,  Prescott  (1935);  H.  A.  Dish- 
ongh,  Little  Rock  (1935). 

Health  and  Public  Instruction — W.  B.  Grayson,  Chairman,  Little 
Rock  (1937);  S.  W.  Douglas,  Eudora  (1937);  B.  M.  Stevenson, 
Crawfordsville  (1937);  H.  K.  Carrington,  Magnolia  (1936);  H.  A. 
Stroud,  Jonesboro  (1936);  J.  H.  Fowler,  Harrison  (1935);  E.  J. 
Munn,  El  Dorado  (1935). 

Medical  Education  and  Hospitals — Joe  F.  Shuffield  Chairman 
Little  Rock  (1937);  David  Levine,  El  Dorado  (1936);  J.  B.  Futrell 
Rector  (1935). 

Public  Relations — D.  A.  Rhinehart,  Chairman,  Little  Rock  ( 1 937) - 
E.  E.  Barlow,  Dermott  (1936);  M.  E.  McCaskill,  Little  Rock  (1935)! 

Medical  Economics — I.  F.  Jones,  Chairman,  Fort  Smith  (1937); 
R.  B.  Robins,  Camden  (1937);  J.  E.  Neighbors,  Stuttgart  (1936); 
D.  E.  White,  El  Dorado  (1936);  Roy  Millard,  Dardanelle  ( 1 935)  ■ 
A.  C.  Shipp,  Little  Rock  (1935);  R.  M.  Sloan,  Jonesboro  (1935). 

Scientific  Exhibit— F.  H.  Krock,  Chairman,  Fort  Smith  ( 1 935) ■ 
H.  King  Wade,  Hot  Springs  National  Park  (1936);  W.  E.  Gray' 
Jr.,  Little  Rock  (1937). 

Arrangements— (Host  Society  1935  meeting)— D.  W.  Goldstein 
Chairman,  C.  S.  Holt,  J.  A.  Foltz,  H.  Moulton,  M.  E.  Foster' 
W.  G.  Eberle,  I.  F.  Jones. 

Necrology— W.  H.  Mock,  Chairman,  Prairie  Grove  (19351-  J. 
M.  Lemons,  Pine  Bluff  (1936);  H.  Moulton,  Fort  Smith  (1937). 

Auxiliary— L.  J.  Kosminsky,  Chairman,  Texarkana  (1935)-  W T 
Wootton,  Hot  Springs  National  Park  (1936)-  C.  S Holt  Fort 
Smith  (1937). 

Cancer  Control— D.  W.  Goldstein,  Chairman,  Fort  Smith  ( 1937) ■ 
R.  L.  Saxon.  Little  Rock  (1936);  L.  A.  Purifoy,  El  Dorado  (1935)! 


THE  COUNTY  SOCIETY 

We  have  often  referred  to  the  fact  that  the  county 
society,  after  all,  is  the  backbone  of  organized  medicine. 
No  matter  how  many  other  medical  organizations  there 
may  be  in  a county,  if  the  county  society  is  not  function- 
ing there  will  be  a corresponding  degree  of  lack  of  in- 
terest in  the  other  organizations. — The  Journal  of  the 
Indiana  State  Medical  Association. 


EDITORIAL 


\ MEDICAL  ECONOMICS 

I.  F.  JONES,  M.  D. 

Ch  airman,  Committee  on  Medical  Economics 

Medical  Economics,  as  such,  was  not  taught 
nor  hardly  thought  of  until  the  past  few  years. 
However,  today,  it  looms  as  a high  light  in  our 
forward  march  toward  the  goal  of  Utopia. 

As  the  chain  store  brought  about  improved 
conditions  among  the  independents,  so  I hope  the 
talk  of  "state  medicine"  and  "contract  practice 
in  medicine"  will  cause  us  to  be  ever  on  the 
alert  for  improvement. 

It  is  a fantastic  idea  for  us  to  think  that  some 
change  is  not  impending.  This  idea,  its  condi- 
tions and  fulfillment,  should  be  brought  about  by 
the  men  in  the  profession  and  not  by  laymen. 
No  layman  has  a proper  conception  of  the  trials, 
troubles  and  tribulations  that  confront  the  diag- 
nosis and  treatment  of  human  ills. 

If  organized  medicine  stands  back  and  allows 
the  politician  and  philanthropist  to  formulate 
some  act  concerning  our  profession  then  we  may 
realize  that  we  will  only  be  puppets  in  the  hands 
of  their  henchmen. 

There  is  to  be  introduced  in  this  Congress  a 
bill  by  the  American  Association  for  Social  Se- 
curity that  could  more  accurately  be  designated, 
A bill  for  the  abolition  of  private  medical  prac- 
tice." As  this  bill  stands,  there  is  no  likelihood 
of  its  passage,  but  it  is  so  diabolical  that  even  a 
revision  would  still  be  worse  than  the  panel  sys- 
tem in  Germany,  admittedly  the  worst  yet. 

We  must  not  only  stand  up  and  take  note  of 
the  aggressiveness  of  our  enemies,  but  must  ever 
be  on  the  alert  to  give  the  best  in  medical  treat- 
ment and  hospitalization  so  that  any  such  bill  or 
act  will  fall  of  its  own  weight.  Only  through  sys- 
tematic study,  work  and  co-operation  of  each  in- 
dividual physician  with  the  County  and  State 
Medical  Society  will  this  be  possible.  So  I urge 
each  and  every  component  society  to  meet,  dis- 
cuss, and  formulate  plans  to  aid  your  state  com- 
mittee in  their  work  against  this  national  evil. 


IN  CONGRESS 

Certain  bills  and  resolutions  have  been  intro- 
duced in  the  national  Congress  vitally  affecting 
the  practice  of  medicine.  Members,  particular- 
ly legislative  committees,  are  urged  to  secure 
copies  of  these  bills  in  order  that  they  may  be 
more  fully  advised  as  to  action  to  be  taken  by 
their  county  societies.  These  are  doubtless  pre- 
liminary to  many  more  of  similar  import  and  if 


Paragould 

Searcy 

Stuttgart 

Gould 
El  Dorado 
Hope 
Hot  Springs 
Little  Rock 
Harrison 
Fort  Smith 


February,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


153 


is  important  that  organized  medicine  inform  it- 
self of  such  proposed  legislation  in  time  to  regis- 
ter an  emphatic  protest  against  unjust  measures. 
Space  does  not  permit  comment  by  The  Journal 
on  the  provisions  of  the  bills  introduced  to  date 
nor  of  their  unfavorable  features.  It  is  hoped 
that  all  members  will  closely  follow  legislative  pro- 
ceedings this  year,  uniting  in  opposition  to  such 
as  are  contrary  to  the  ideals  and  ethics  of  or- 
ganized medicine.  Introduced  the  first  two  days 
of  the  74th  Congress  were: 

H.  R.  43,  introduced  by  Rudd  of  New  York:  "Granting 
hospital  treatment  to  postal  employees  suffering  from 
tuberculosis,  nervous  diseases,  or  kindred  occupational 
ailments  in  government-owned  hospitals." 

H.  R.  1900,  introduced  by  Bland  of  Virginia:  "Authoriz- 
ing hospitalization  for  retired  or  disabled  seamen." 

H.  R.  2859,  introduced  by  Sabath,  of  Illinois:  "To  pro- 
vide for  the  establishment  of  unemployment  and  social 
insurance,  and  for  other  purposes." 

H.  R.  2902,  introduced  by  Welch  of  California:  "To 
extend  the  benefits  of  the  United  States  Public  Health 
Service  to  fishermen,  trapmen,  net  tenders,  and  other  per- 
sons subject  to  the  laws  relating  to  American  seamen." 

S.  R.  28,  introduced  by  Black  of  Alabama:  "Resolved, 
that  the  Committee  on  Education  and  Labor  of  the  Sen- 
ate is  hereby  directed  and  instructed,  either  acting 
through  the  full  committee  or  through  a duly  appointed 
sub-committee,  as  soon  as  practicable,  to  make  a full  and 
complete  investigation  in  order  to  determine  the  best 
and  most  effective  kind  of  Federal  legislation  to  provide 
a system  of  health  insurance  throughout  the  entire  United 
States,  and  to  report  to  the  Senate  as  early  as  practicable 
the  recommendations  outlining  the  kind  of  legislation  it 
is  believed  will  most  effectively  accomplish  this  pur- 
pose." 


SOCIALIZED  MEDICINE 

The  December  1934  issue  of  Survey-Graphic, 
entitled  "Buying  Health,"  presents  expressions  of 
the  policies  of  several  organizations  on  so-called 
socialization  of  medicine.  These  are  in  the  main 
not  new  statements,  but  a reading  of  this  issue 
will  be  of  profit  to  every  physician  from  the 
broadening  of  his  viewpoint  to  include  the  opin- 
ions of  other  groups. 

Of  particular  interest  are  the  rather  caustic 
comments  of  Wm.  T.  Foster,  an  economist,  who 
challenges  organized  medicine's  right  to  control 
the  manner  of  distribution  and  costs  of  medical 
care.  It  seems  but  natural  in  these  days  of  need- 
ed economic  rehabilitation  to  view  with  doubts 
the  pronouncements  of  our  leaders  of  a few  years 
ago  in  the  field  of  economics.  This  authority  as- 
serts that  adequate  medical  care  is  not  available 
to  the  masses  of  our  people  and  that  there  are 
thousands  of  physicians  harassed  by  debt  and 
general  financial  insecurity.  These  assertions  we 


accept  as  truths.  But  is  medical  care  the  only 
service  or  commodity  not  generally  available? 
Are  physicians  the  only  class  harassed  by  debts 
and  general  financial  insecurity?  One  pauses  to 
wonder  if  any  of  the  citizens  of  this  nation  do 
not  feel  the  pangs  of  hunger?  Are  there  re- 
spectable citizens  whose  self-esteem  could  not  be 
elevated  by  the  acquisition  of  a much-needed 
new  suit  of  clothes?  The  answer  to  these  ques- 
tions is  at  hand  in  our  daily  travels.  Yet  we  hear 
of  no  organized  movement  to  provide  these  com- 
modities by  a similar  Utopian  plan.  Without 
benefit  of  statistics,  we  hazard  the  assumption 
that  the  proportion  of  the  hungry  and  ragged 
among  our  people  today  far  exceeds  those  who 
are  in  comparative  need  of  medical  attention. 
Social  workers  of  our  acquaintance  assure  us 
that  lack  of  financial  sustenance  is  of  far  greater 
moment  to  the  unemployed  and  lower  income 
groups  today  than  is  the  need  for  improvement 
in  medical  care  now  available. 

The  fact  that  many  people  need  but  can  not 
obtain  adequate  medical  service  is  not  to  be  de- 
nied. It  is  peculiarly  the  duty  of  the  medical 
profession  to  correct  this  defect  in  our  present 
system.  However,  we  do  not  hold  that  such 
correction  can  more  efficiently  ensue  from  the 
edicts  of  a political  government.  Consideration 
of  the  condition  of  our  school  systems  and  our 
governmental  activities  in  general  constitutes  a 
poor  recommendation  for  an  extension  of  govern- 
mental activity  into  the  field  of  health  control. 

The  Journal  again  reiterates  its  position  that 
individual  physicians  must  become  fully  informed 
of  the  various  economic  and  social  suggestions 
for  a change  in  medical  practice.  It  is  not  enough 
for  your  officers  and  your  committee  on  medical 
economics  to  interest  themselves  in  these  prob- 
lems. Every  member  of  the  profession  is  vitally 
concerned;  it  is  his  duty  to  study  all  proposals 
to  better  inform  himself  and  his  clientele  of  their 
defects  or  possible  benefits.  The  periodical  quot- 
ed is  recommended  as  a beginning  in  this  study. 
The  Journal's  copy  may  be  obtained  on  loan  if 
not  otherwise  available  to  our  members. 

<s> 

EDITORIAL  COMMENT 


The  1935  Plan  of  Procedure  for  the  Summer 
Round-up  of  Children,  a pamphlet  descriptive 
of  this  health  activity  of  the  National  Congress 
of  Parents  and  Teachers,  has  been  received  by 
The  Journal.  In  reviewing  the  booklet,  we  are 
encouraged  by  certain  statements  which  appear 
(Continued  on  Page  159) 


O 3 


154 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  9 


CONSTITUTION  AND  BY-LAWS 

OF  THE 

ARKANSAS  MEDICAL  SOCIETY 

1934* 


CONSTITUTION 

ARTICLE  I.— NAME  OF  THE  SOCIETY 

The  name  and  title  of  this  organization  shall  be  the 
Arkansas  Medical  Society. 

ARTICLE  II.— PURPOSES  OF  THE  SOCIETY 

The  purposes  of  this  Society  shall  be  to  federate  and 
bring  into  one  compact  organization  the  entire  medical 
profession  of  the  State  of  Arkansas  and  to  unite  with 
similar  societies  of  other  States  to  form  the  American 
Medical  Association;  to  extend  medical  knowledge  and 
advance  medical  science;  to  elevate  the  standard  of  medi- 
cal education,  and  to  secure  the  enactment  and  enforce- 
ment of  just  medical  laws;  to  promote  friendly  inter- 
course among  physicians;  to  guard  and  foster  the 
material  interests  of  its  members  and  to  protect  them 
against  imposition;  and  to  enlighten  and  direct  public 
opinion  in  regard  to  the  great  problems  of  state  medi- 
cine, so  that  the  profession  shall  become  more  capable 
and  honorable  within  itself,  and  more  useful  to  the  public, 
in  the  prevention  and  cure  of  disease,  and  in  prolonging 
and  adding  comfort  to  life. 

ARTICLE  III.— COMPONENT  SOCIETIES 

Component  Societies  shall  consist  of  those  county  medi- 
cal societies  which  hold  charters  from  this  Society. 

ARTICLE  IV.— COMPOSITION  OF  THE  SOCIETY 

SECTION  I.  This  Society  shall  consist  of  members, 
delegates  and  guests. 

SEC.  2.  MEMBERS.  The  members  of  this  Society 
shall  be  the  members  of  the  component  county  medical 
societies. 

SEC.  3.  DELEGATES.  Delegates  shall  be  those  mem- 
bers who  are  elected  in  accordance  with  this  Constitution 
and  By-Lav/s  to  represent  their  respective  component 
societies  in  the  House  of  Delegates  of  this  Society. 

SEC.  4.  GUESTS.  Any  distinguished  physician  not  a 
resident  of  this  State,  who  is  a member  of  his  own  State 
Society,  may  become  a guest  during  any  Annual  Session 
on  invitation  of  the  officers  of  this  Society,  and  shall 
be  accorded  the  privilege  of  participating  in  all  of  the 
scientific  work  for  that  Session. 

ARTICLE  V.— HOUSE  OF  DELEGATES 

The  House  of  Delegates  shall  be  the  legislative  body  of 
the  Society,  and  shall  consist  of:  ( I ) Delegates  elected 
by  the  component  county  societies;  (2)  The  Councilors; 
and  (3)  ex-officio,  the  President,  Secretary  and  Ex- 
Presidents  of  this  Society;  provided,  however,  that  the 
Ex-Presidents  shall  not  have  the  power  of  voting. 

ARTICLE  VI.— COUNCIL 

The  Council  shall  consist  of  the  Councilors,  and  the 
President  and  Secretary,  ex-officio.  Besides  its  duties 

entioned  in  the  By-Laws,  it  shall  constitute  the  Finance 

ommittee  of  the  House  of  Delegates.  Six  Councilors 
shall  constitute  a quorum. 

* As  amended  at  the  Fifty-ninth  Annual  Session,  April  16-18, 


ARTICLE  VII.— SECTIONS  AND  DISTRICT  SOCIETIES 

The  House  of  Delegates  may  provide  for  a division 
of  the  scientific  work  of  the  Society  into  appropriate 
sections,  and  for  the  organizations  of  such  Councilor 
District  Societies  as  will  promote  the  best  interests  of 
the  profession,  such  societies  to  be  composed  exclusively 
of  members  of  component  county  societies. 

ARTICLE  VII.— SESSIONS  AND  MEETINGS 

SECTION  I.  The  Society  shall  hold  an  Annual  Ses- 
sion, during  which  there  shall  be  held  daily  general 
meetings,  which  shall  be  open  to  all  registered  members 
and  guests. 

SEC.  2.  The  place  for  holding  each  annual  session  shall 
be  decided  by  the  House  of  Delegates.  After  conferring 
with  the  President  and  Secretary  of  the  society,  the  time 
for  holding  each  annual  meeting  shall  be  decided  by  the 
Committee  on  Arrangements  of  the  component  society  of 
the  county  in  which  the  meeting  is  to  be  held. 

ARTICLE  IX.— OFFICERS 

SECTION  I.  The  officers  of  this  Society  shall  be  a 
President,  President-Elect,  three  Vice-Presidents,  a Secre- 
tary, a Treasurer  and  ten  Councilors. 

SEC.  2.  The  officers,  except  the  Councilors,  shall  be 
elected  annually.  The  terms  of  the  Councilors  shall  be 
for  two  years,  those  first  elected  serving  one  and  two 
years,  as  may  be  arranged,  so  that  after  the  first  year  five 
Councilors  shall  be  elected  annually  to  serve  two  years. 
All  these  officers  shall  serve  until  their  successors  are 
elected  and  installed. 

ARTICLE  X.— RECIPROCITY  OF  MEMBERSHIP  WITH 
OTHER  STATE  SOCIETIES 

In  order  to  broaden  professional  fellowship  this  Society 
is  ready  to  arrange  with  other  State  Medical  Societies  for 
an  interchange  of  certificates  of  membership,  so  that 
members  moving  from  one  state  to  another  may  avoid 
the  formality  of  re-election. 

ARTICLE  XI.— FUNDS  AND  EXPENSES 

Funds  shall  be  raised  by  an  equal  per  capita  assess- 
ment on  each  component  society.  The  amount  of  the 
assessment  shall  be  fixed  by  the  House  of  Delegates,  but 
shall  not  exceed  the  sum  of  $5.00  per  capita  per  annum, 
except  on  four-fifths  vote  of  the  Delegates  present.  Funds 
may  also  be  raised  by  voluntary  contributions,  from  the 
Society's  publications  and  in  any  other  manner  approved 
by  the  House  of  Delegates.  Funds  may  be  appropriated 
by  the  House  of  Delegates  to  defray  the  expenses  of 
the  Society  for  publications,  and  for  such  other  pur- 
poses as  will  promote  the  welfare  of  the  profession.  All 
resolutions  appropriating  funds  must  be  referred  to  the 
Finance  Committee  before  action  is  taken  thereon. 

ARTICLE  XII.— REFERENDUM 

SECTION  I.  A General  Meeting  of  the  Society  may, 
by  a two-thirds  vote  of  the  members  present,  order  a 
general  referendum  on  any  question  pending  before  the 
House  of  Delegates  and  when  so  ordered  the  House  of 
Delegates  shall  submit  such  questions  to  the  members  of 
the  Society,  who  may  vote  by  mail  or  in  person,  and,  if 
the  members  voting  shall  comprise  a majority  of  all  the 
members  of  the  Society,  a majority  of  such  vote  shall 
determine  the  question  and  be  binding  on  the  House  of 
Delegates. 

SEC.  2.  The  House  of  Delegates  may,  by  a two-thirds 
vote  of  its  own  members,  submit  any  question  before  it  to 
a general  referendum,  as  provided  in  the  preceding  sec- 


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ARKANSAS  MEDICAL  SOCIETY 


155 


tion,  and  the  result  shall  be  binding  on  the  House  of 
Delegates. 

ARTICLE  XIII.— THE  SEAL 

The  Society  shall  have  a common  seal,  with  power  to 
break,  change  or  renew  the  same  at  pleasure. 

ARTICLE  XIV.— AMENDMENTS 

The  House  of  Delegates  may  amend  any  article  of  this 
Constitution  by  a two-thirds  vote  of  the  Delegates  pres- 
ent at  any  Annual  Session,  provided  that  such  amend- 
ment shall  have  been  presented  in  open  meeting  at  the 
previous  Annual  Session,  and  that  it  shall  have  been 
published  twice  during  the  year  in  a bulletin  or  Jour- 
nal of  this  Society,  or  sent  officially  to  each  component 
society  at  least  two  months  before  the  meeting  at  which 
final  action  is  to  be  taken. 


BY-LAWS 

CHAPTER  I.— MEMBERSHIP 

SECTION  I.  The  name  of  a physician  on  the  properly 
certified  roster  of  members  of  a component  society 
which  has  paid  its  annual  assessment,  shall  be  prima  facie 
evidence  of  membership  in  this  Society. 

SEC.  2.  Any  person  who  is  under  sentence  of  sus- 
pension or  expulsion  from  a component  society,  or  whose 
name  has  been  dropped  from  its  roll  of  members,  shall 
not  be  entitled  to  any  of  the  rights  or  benefits  of  this 
Society,  nor  shall  he  be  permitted  to  take  part  in  any 
of  its  proceedings  until  he  has  been  relieved  of  such  dis- 
ability. 

SEC.  3.  Each  member,  each  member  chosen  as  a dele- 
gate, and  each  guest  in  attendance  at  an  Annual  Session 
Session  of  the  Society  shall  register  in  such  manner  as 
may  be  provided  by  the  Secretary,  giving  his  name, 
address,  and  the  component  society  of  which  he  is  a 
member.  When  his  right  to  membership  has  been  verified 
by  reference  to  the  roster  of  his  society,  he  shall  receive 
a badge  which  shall  be  evidence  of  his  right  to  all  the 
privileges  of  membership  at  that  session.  No  member 
shall  take  part  in  any  of  the  proceedings  of  an  Annual 
Session  until  he  has  complied  with  the  provisions  of 
this  section. 

SEC.  4.  A physician  who  has  been  a continuous  mem- 
ber for  a term  of  fifteen  years,  who  is  not  less  than 
sixty-five  years  of  age,  who  is  an  honorary  member  of 
his  county  society,  may  have  his  name  carried  on  the 
roster  of  the  State  Society  and  receive  its  publication  as 
an  honorary  member  and  the  component  society  shall 
be  exempt  from  payment  of  the  annual  assessment  for 
his  membership.  An  honorary  member  shall  have  the 
same  privilege  as  other  members. 

CHAPTER  II.— ANNUAL  AND  SPECIAL  SESSIONS  OF 
THE  SOCIETY 

SECTION  I.  The  Society  shall  hold  an  Annual  Session 
at  such  time  and  place  as  has  been  fixed  by  the  House 
of  Delegates  at  the  preceding  Annual  Session. 

SEC.  2.  Special  Meetings  of  either  the  Society  or  of 
the  House  of  Delegates  shall  be  called  by  the  President 
on  petition  of  twenty  delegates  or  fifty  members. 

CHAPTER  III.— GENERAL  MEETINGS 

SECTION  I.  All  registered  members  may  attend  and 
participate  in  the  proceedings  and  discussions  of  the 
General  Meetings  and  of  the  Sections.  The  General 
Meetings  shall  be  presided  over  by  the  President  or  by 
one  of  the  Vice-Presidents,  and  before  them  shall  be 


heard  the  address  of  the  President  and  the  orations,  and 
such  scientific  papers  and  discussions  as  may  be  arranged 
for  in  the  program. 

SEC.  2.  The  General  Meetings  may  recommend  to 
the  House  of  Delegates  the  appointment  of  committees 
or  commissions  for  scientific  investigation  of  special  inter- 
est and  importance  to  the  profession  and  public. 

CHAPTER  IV.— HOUSE  OF  DELEGATES 

SECTION  I.  The  House  of  Delegates  shall  meet  on 
the  first  day  of  the  Annual  Session.  It  may  adjourn  from 
time  to  time  as  may  be  necessary  to  complete  its  busi- 
ness; provided  that  its  hours  shall  conflict  as  little  as 
possible  with  the  General  Meetings.  The  order  of  busi- 
ness shall  be  arranged  as  a separate  section  of  the 
program. 

SEC.  2.  Each  component  county  society  shall  be  en- 
titled to  send  to  the  House  of  Delegates  each  year  one 
delegate  for  every  twenty-five  members,  and  one  for 
each  major  fraction  thereof,  provided  that  its  annual 
report  and  assessments  are  in  the  hands  of  the  Secretary 
thirty  days  prior  to  the  annual  meeting.  Each  compon- 
ent society,  however,  regardless  of  its  number  of  mem- 
bers, which  has  complied  with  this  Section,  is  entitled 
to  one  delegate. 

SEC.  3.  A majority  of  the  Delegates  registered  shall 
constitute  a quorum. 

SEC.  4.  It  shall,  through  its  officers;  council  and 
otherwise,  give  diligent  attention  to  and  foster  the  scien- 
tific work  and  spirit  of  the  Society,  and  shall  constantly 
study  and  strive  to  make  each  Annual  Session  a stepping- 
stone  to  future  ones  of  higher  interest. 

SEC.  5.  It  shall  consider  and  advise  as  to  the  material 
interests  of  the  profession,  and  of  the  public  in  those 
important  matters  wherein  it  is  dependent  on  the  pro- 
fession, and  shall  use  its  influence  to  secure  and  enforce 
all  proper  medical  and  public  health  legislation,  and  to 
diffuse  popular  information  in  relation  thereto. 

SEC.  6.  It  shall  make  careful  inquiry  into  the  condition 
of  the  profession  of  each  county  in  the  State,  and  shall 
have  authority  to  adopt  such  methods  as  may  be  deemed 
most  efficient  for  building  up  and  increasing  the  interest 
in  such  county  societies  as  already  exist,  and  for  organ- 
izing the  profession  in  counties  where  societies  do  not 
exist.  It  shall  especially  and  systematically  endeavor  to 
promote  friendly  intercourse  among  physicians  of  the 
same  locality,  and  shall  continue  these  efforts  until  every 
physician  in  every  county  of  the  State  who  is  reputable 
and  eligible  has  been  brought  under  medical  society  in- 
fluence. 

SEC.  7.  It  shall  encourage  post-graduate  and  research 
work,  as  well  as  home  study,  and  shall  endeavor  to  have 
the  results  utilized  and  intelligently  discussed  in  the 
county  societies. 

SEC.  8.  It  shall  elect  representatives  to  the  House  of 
Delegates  of  the  American  Medical  Association  in  ac- 
cordance with  the  Constitution  and  By-Laws  of  that 
body. 

SEC.  9.  It  shall  divide  the  State  into  Councilor  Dis- 
tricts, specifying  what  counties  each  district  shall  in- 
clude, and,  when  the  best  interest  of  the  Society  and  pro- 
fession will  be  promoted  thereby,  organize  in  each,  a 
district  medical  society,  and  all  members  of  component 
county  societies  shall  be  members  in  such  district  society. 

SEC.  10.  It  shall  have  authority  to  appoint  committees 
for  special  purposes  from  among  members  of  the  Society 
who  are  not  members  of  the  House  of  Delegates.  Such 


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[Vol.  XXXI,  No.  9 


committees  shall  report  to  the  House  of  Delegates,  and 
may  be  present  and  participate  in  the  debate  on  their 
reports. 

SEC  II.  It  shall  approve  all  memorials  and  resolutions 
issued  in  the  name  of  the  Society  before  they  shall  be- 
come effective. 

CHAPTER  V.— ELECTION  OF  OFFICERS 

SEC.  I.  Immediately  after  adjournment  of  the  first 
meeting  of  the  House  of  Delegates  at  each  Annual  Ses- 
sion, the  delegates  from  the  component  societies  of  each 
councilor  district  shall  meet,  the  councilor  acting  as 
chairman,  and  select  one  delegate  from  each  district 
to  form  a Committee  on  Nominations.  This  Committee 
shall  consist  of  ten  delegates,  one  from  each  councilor 
district.  It  shall  meet  and  organize  by  selecting  a chair- 
man and  secretary.  It  shall  be  the  duty  of  this  committee 
to  consult  with  the  members  of  the  Society  and  to  hold 
one  or  more  meetings  at  which  the  best  interest  of  the 
Society  and  of  the  profession  of  the  State  for  the  en- 
suing year  shall  be  carefully  considered.  The  committee 
shall  report  the  result  of  its  deliberations  to  the  House 
of  Delegates  in  the  shape  of  a ticket  containing  the 
names  of  the  three  members  for  the  office  of  President- 
Elect  and  of  one  member  for  each  of  the  other  offices  to 
be  filled  at  that  Annual  Session.  No  two  candidates  for 
President-Elect  shall  be  named  from  the  same  county. 

SEC.  2.  All  elections  shall  be  by  ballot,  except  where 
there  is  only  one  candidate,  when  election  may  be  made 
by  acclamation,  and  a majority  of  the  votes  cast  shall  be 
necessary  to  elect. 

SEC.  3.  The  report  of  the  Nominating  Committee 
shall  be  the  first  order  of  business  of  the  House  of  Dele- 
gates on  the  afternoon  of  the  last  day  of  the  Annual 
Session. 

SEC.  4.  The  election  of  officers  shall  be  the  second 
order  of  business  of  the  House  of  Delegates  on  the  after- 
noon of  the  last  day  of  the  Annual  Session. 

SEC.  5.  Any  person  known  to  have  solicited  votes 

for  or  sought  any  office  within  the  gift  of  this  Society 
shall  be  ineligible  for  any  office  for  two  years.  No 
member  shall  be  eligible  to  any  office  of  this  Society 
who  is  not  in  attendance  at  the  meeting  at  which  the 
election  is  held. 

CHAPTER  VI.— DUTIES  OF  OFFICERS 

SECTION  I.  The  President  shall  preside  at  all  meet- 
ings of  the  Society  and  of  the  House  of  Delegates;  shall 
appoint  all  committees  not  otherwise  provided  for;  he 
shall  deliver  an  annual  address  at  such  time  as  may  be 
arranged,  and  shall  perform  such  duties  as  custom  and 
parliamentary  usage  may  require.  He  shall  be  the  real 
head  of  the  profession  of  the  State  during  his  term  of 
office,  and,  as  far  as  practicable,  shall  visit,  by  appoint- 
ment, the  various  sections  of  the  State  and  assist  the 
Councilors  in  building  up  the  county  societies,  and  in 
making  their  work  more  practical  and  useful. 

SEC.  2.  The  President-Elect  shall  be  a member  ex- 
officio  of  the  Council  and  the  House  of  Delegates  with- 
out the  power  of  voting.  It  shall  be  his  duty  to  assist 
the  President  in  visiting  the  component  county  and  the 
district  societies,  and  to  familiarize  himself  with,  and 
prepare  himself  for,  the  performance  of  his  duties  when 
he  shall  have  succeeded  to  the  presidency  of  the  Society. 

SEC.  3.  The  Vice-President  shall  assist  the  President 
in  the  discharge  of  his  duties.  In  the  event  of  the  Presi- 
dent's death,  resignation  or  removal,  the  Council  shall 
select  one  of  the  Vice-Presidents  to  succeed  him. 


SEC.  4.  The  Treasurer  shall  give  bond  in  the  sum 
of  $6,000.  He  shall  demand  and  receive  all  funds 
due  the  Society,  together  with  bequests  and  donations. 
He  shall  pay  money  out  of  the  Treasury  only  on  a written 
order  of  the  Secretary;  he  shall  subject  his  accounts  to 
such  examination  as  the  House  of  Delegates  may  order, 
and  he  shall  annually  render  an  account  of  his  doings 
and  of  the  state  of  the  funds  in  his  hands. 

SEC.  5.  The  Secretary  shall  give  bond  in  the  sum  of 
$3,000;  he  shall  attend  the  general  meetings  of  the 
Society  and  the  meetings  of  the  House  of  Delegates,  and 
shall  keep  minutes  of  their  respective  proceedings  in  sep- 
arate record  books.  He  shall  be  ex-officio  Secretary  of 
the  Council.  He  shall  be  custodian  of  all  record  books 
and  papers  belonging  to  the  Society,  except  such  as 
properly  belong  to  the  Treasurer,  and  shall  keep  account 
of  and  promptly  turn  over  to  the  Treasurer  all  funds  of 
the  Society  which  come  into  his  hands.  He  shall  pro- 
vide for  the  registration  of  the  members  and  delegates 
at  the  Annual  Session.  He  shall,  with  the  co-operation  of 
the  secretaries  of  the  component  societies,  keep  a regis- 
ter of  all  the  legal  practitioners  in  the  State  by  counties, 
noting  on  each,  his  status  in  relation  to  his  county  so- 
ciety, and,  on  request,  shall  transmit  a copy  of  this 
list  to  the  American  Medical  Association.  He  shall  aid 
the  Councilors  in  the  organization  and  improvement  of 
the  county  societies  and  in  the  extension  of  the  power 
and  usefulness  of  this  Society.  He  shall  conduct  the 
official  correspondence,  notifying  members  of  meetings, 
officers  of  their  election  and  committees  of  their  appoint- 
ment and  duties.  He  shall  employ  such  assistants  as  may 
be  ordered  by  the  House  of  Delegates,  and  shall  make 
an  annual  report  to  the  House  of  Delegates.  He  shall 
supply  all  component  societies  with  the  necessary  blanks 
for  making  their  annual  reports;  shall  keep  an  account 
with  the  component  societies,  charging  against  each  so- 
ciety its  assessment,  collect  the  same  and  turn  it  over 
to  the  Treasurer,  taking  his  receipt  therefor.  Acting  with 
the  Committee  on  Scientific  Work,  he  shall  prepare  and 
issue  all  programs.  The  amount  of  his  salary  shall  be 
fixed  by  the  House  of  Delegates. 

SEC.  6.  The  Council  shall  have  authority  to  accept 
or  reject  all  bonds. 

CHAPTER  VII.— COUNCIL 

SECTION  I.  The  Council  shall  meet  on  the  first  day 
of  the  Annual  Session  and  daily  during  the  session  and 
at  such  other  times  as  necessity  may  require,  subject  to 
the  call  of  the  chairman  or  on  a petition  of  three  Coun- 
cilors. It  shall  meet  on  the  last  day  of  the  Annual  Session 
of  the  Society  to  organize  and  outline  the  work  for  the 
ensuing  year.  It  shall  select  a chairman  and  a clerk, 
who,  in  the  absence  of  the  Secretary  of  the  Society,  shall 
keep  a record  of  its  proceedings.  It  shall  through  its 
chairman,  make  an  annual  written  report  to  the  House 
of  Delegates'. 

SEC.  2.  Each  Councilor  shall  be  organizer,  peace- 
maker and  censor  for  his  district.  He  shall  visit  the 
counties  in  his  district  at  least  once  a year  for  the  pur- 
pose of  organizing  component  societies  where  none  exist, 
for  inquiring  into  the  condition  of  the  profession,  and 
for  improving  and  increasing  the  zeal  of  the  county 
societies  and  their  members.  He  shall  make  an  annual 
written  report  of  his  work,  and  of  the  condition  of  the 
Profession  of  each  county  in  his  district  at  the  Annual 
Session  of  the  House  of  Delegates.  The  necessary  travel- 
ing expenses  incurred  by  such  Councilor  in  the  line  of 
the  duties  herein  imposed  may  be  allowed  on  a properly 


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ARKANSAS  MEDICAL  SOCIETY 


157 


itemized  statement;  but  this  shall  not  be  construed  to  in- 
clude his  expenses  in  attending  the  Annual  Session  of 
the  Society. 

SEC  3.  The  Council  shall  be  the  executive  body  of 
the  House  of  Delegates  and  between  Annual  Sessions 
shall  exercise  the  power  conferred  on  the  House  of  Dele- 
gates by  the  Constitution  and  By-Laws.  It  shall  consider 
all  questions  involving  the  right  and  standing  of  mem- 
bers, whether  in  relation  to  other  members,  to  the  com- 
ponent societies,  or  to  this  Society.  All  questions  of  an 
ethical  nature  brought  before  the  House  of  Delegates  or 
the  general  meeting  shall  be  referred  to  the  Council 
without  discussion.  It  shall  hear  and  decide  all  questions 
of  discipline  affecting  the  conduct  of  members  or  com- 
ponent societies,  on  which  an  appeal  is  taken  from  the 
decision  of  an  individual  Councilor. 

SEC.  4.  In  sparsely  settled  sections  it  shall  have  au- 
thority to  organize  the  physicians  of  two  or  more  coun- 
ties into  societies,  to  be  suitably  designated  so  as  to 
distinguish  them  from  district  societies,  and  these  so- 
cieties, when  organized  and  chartered,  shall  be  entitled 
to  all  rights  and  privileges  provided  for  component  so- 
cieties until  such  counties  shall  be  organized  separately. 

SEC.  5.  The  Council  shall  provide  for  and  superintend 
the  publication  and  distribution  of  all  proceedings,  trans- 
actions and  memoirs  of  the  Society,  and  shall  have  au- 
thority to  appoint  an  editor  and  such  assistants  as  it 
deems  necessary.  All  money  received  by  the  Council 
and  its  agents,  resulting  from  the  discharge  of  the  duties 
assigned  to  them,  must  be  paid  to  the  Treasurer  of  the 
Society.  It  shall  annually  audit  the  accounts  of  the 
Treasurer  and  Secretary  and  other  agents  of  this  So- 
ciety and  present  a statement  of  the  same  in  its  annual 
report  to  the  House  of  Delegates,  which  report  shall  also 
specify  the  character  and  cost  of  all  the  publications  of 
the  Society  during  the  year,  and  the  amount  of  all  other 
property  belonging  to  the  Society  under  its  control,  with 
such  suggestions  as  it  may  deem  necessary.  In  the  event 
of  a vacancy  in  the  office  of  the  Secretary  or  of  the 
Treasurer,  the  Council  shall  fill  the  vacancy  until  the 
next  annual  election. 

SEC.  6.  In  case  of  a vacancy  in  the  office  of  dele- 
gate, the  Council  shall  have  authority  to  seat  any  member 
of  that  county  society  in  attendance  at  said  meeting  as 
delegate,  with  full  right  to  perform  all  the  duties  of 
that  office. 

CHAPTER  VIII.— COMM ITTEES 

SECTION  I.  The  standing  committees  of  this  Society 
shall  be  as  follows: 

1.  A Committee  on  Scientific  Work. 

2.  A Committee  on  Medical  Legislation. 

3.  A Committee  on  Health  and  Public  Instruction. 

4.  A Committee  on  Medical  Education  and  Hospitals. 

5.  A Committee  on  Public  Relations. 

6.  A Committee  on  Medical  Economics. 

7.  A Committee  on  Scientific  Exhibit. 

8.  A Committee  on  Arrangements. 

Unless  otherwise  provided,  these  committees  shall  be 
appointed  by  the  President.  Each  committee  shall  con- 
sist of  at  least  three  members.  A greater  number  may 
be  appointed  whenever  circumstances  require  a larger 
committee.  As  far  as  practicable,  appointments  shall 
be  made  so  that  the  term  of  office  of  a third  of  the 
members  of  each  committee  shall  expire  each  year.  The 
President  and  Secretary  shall  be  ex-officio  members  of 
all  committees. 


SEC  2.  The  Committee  on  Scientific  Work  shall  con- 
sist of  three  members  of  which  the  Secretary  shall  be 
one.  Subject  to  the  instructions  of  the  House  of  Dele- 
gates, this  committee  shall  determine  the  character  and 
scope  of  the  scientific  proceedings  for  each  Annual  Ses- 
sion. It  shall  prepare  a scientific  program  for  each 
Annual  Session,  determining  the  order  in  which  papers 
and  discussions  shall  be  presented. 

SEC.  3.  The  Committee  on  Medical  Legislation  shall 
consist  of  seven  members.  It  shall  represent  the  Society  in 
all  legislative  practice.  It  shall  keep  in  touch  with  pro- 
fessional and  public  opinion  and  maintain  active  relations 
with  the  Bureau  of  Legal  Medicine  and  Legislation  of 
the  American  Medical  Association.  It  shall,  at  all  times, 
endeavor  to  shape  and  guide  legislation  with  a view  to 
securing  the  best  results  for  the  whole  people.  It  shall 
strive  to  organize  professional  influence  so  as  to  promote 
the  general  good  of  the  community  in  local,  state,  and 
national  affairs  and  elections.  During  sessions  of  the  Gen- 
eral Assembly,  it  shall  keep  itself  informed  as  to  the  bills 
that  are  introduced,  and  shall  inform  the  members  of  the 
Society  through  its  Journal  or  by  special  bulletins,  to  the 
end  that  legislation  inimical  to  the  medical  profession 
and  the  public  shall  be  defeated,  and  legislation  foster- 
ing the  interests  of  public  health  and  medical  practice 
shall  be  enacted  into  law. 

SEC.  4.  The  Committee  on  Health  and  Public  Instruc- 
tion shall  represent  the  Society  in  those  affairs  having 
for  their  object  the  improvement  in  public  and  personal 
health,  the  prevention  of  epidemics,  and  the  instruction 
of  the  people.  It  shall  maintain  close  relations  with  the 
Board  of  Health,  the  State  Health  Officer,  and  the  vari- 
ous health  officials,  assisting  in  the  adoption  of  public 
health  programs,  the  enforcement  of  sanitary  laws,  and 
the  promulgation  of  other  health  activties  of  interest 
to  the  members  of  the  Society.  As  occasion  demands  or 
when  thought  advisable,  it  shall  supervise  the  preparation 
of  articles  of  timely  interest  for  publication  in  the  news- 
papers or  for  broadcasting  over  the  radio  for  the  in- 
struction of  the  public. 

SEC.  5.  The  Committee  on  Medical  Education  and 
Hospitals  shall  serve  this  State  for  the  Committee  on 
Medical  Education  and  Hospitals  of  the  American  Medi- 
cal Association  ,and  shall  have  referred  to  it  all  ques- 
tions pertaining  to  hospitals  and  medical  education.  It 
shall  maintain  close  relations  with  the  officials  and  faculty 
of  the  University  of  Arkansas  School  of  Medicine,  render- 
ing at  all  times  such  assistance  as  it  can  in  maintaining 
that  institution  as  a Class  A Medical  School. 

SEC  6.  The  Committee  on  Public  Relations  shall  have 
referred  to  it  all  questions  wherein  the  medical  profes- 
sion as  represented  by  the  Society  is  called  upon  for  ad- 
vice, for  participation  in  private  or  public  affairs  and 
projects  not  coming  within  the  duties  outlined  for  the 
other  committees.  It  shall  be  the  publicity  committee 
of  the  Society  and  shall  have  charge  of  all  publicity  is- 
sued in  the  name  of  the  Society. 

SEC.  7.  The  Committee  on  Medical  Economics  shall 
serve  the  State  for  the  Council  on  Medical  Economics 
of  the  American  Medical  Association.  It  shall  investigate 
all  matters  affecting  the  economic  status  of  physicians 
and  shall  report  annually  to  the  House  of  Delegates,  such 
recommendations  as  may,  in  its  judgment,  seem  proper. 

SEC.  8.  The  Committee  on  Scientific  Exhibit  shall  solicit 
and  collect  material  from  institutions  and  individual  phy- 
sicians of  the  State  that  is  of  scientific  interest.  This  it 
shall  arrange  and  exhibit  at  each  Annual  Session.  It  should 


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[Vol.  XXXI,  No.  9 


particularly  strive  to  obtain  material  that  will  more  fully 
illustrate  the  papers  presented  in  the  general  meetings 
of  the  Society. 

SEC.  9.  The  Committee  on  Arrangements  shall  be  ap- 
pointed by  the  component  society  of  the  county  in 
which  the  Annual  Session  is  to  be  held.  With  the  Presi- 
dent and  Secretary  it  shall  select  the  time  of  the  Annual 
Session.  It  shall  provide  suitable  accommodations  for 
the  meeting  places  of  the  Society  and  the  House  of 
Delegates,  the  scientific  exhibit,  the  committees,  and  shall 
have  general  charge  of  all  arrangements.  Its  chairman 
shall  report  an  outline  of  the  arrangements  to  the  Secre- 
tary for  publication  in  the  program  and  shall  make  ad- 
ditional announcements  during  the  session  as  occasion 
may  require. 

CHAPTER  IX.— COUNTY  SOCIETIES 

SECTION  I.  All  county  societies  now  in  affiliation 
with  this  Society  or  those  which  may  hereafter  be  organ- 
ized in  this  State,  v/hich  have  adopted  principles  of  or- 
ganization not  in  conflict  with  this  Constitution  and  By- 
Laws,  shall,  on  application,  receive  a charter  from  and 
become  a component  part  of  this  Society. 

SEC  2.  As  rapidly  as  can  be  done  after  the  adoption 
of  this  Constitution  and  By-Laws,  a medical  society  shall 
be  organized  in  every  county  in  the  State  in  which  no 
component  society  exists,  and  charters  shall  be  issued 
thereto. 

SEC.  3.  Charters  shall  be  issued  only  on  approval  of 
the  Council,  and  shall  be  signed  by  the  President  and 
Secretary  of  this  Society.  Upon  the  recommendation  of 
the  Council,  the  House  of  Delegates  may  revoke  the 
charter  of  any  component  society  whose  actions  are  in 
conflict  with  the  letter  or  spirit  of  this  Constitution  and 
By-Laws. 

SEC.  4.  Only  one  component  medical  society  shall  be 
chartered  in  any  county.  Where  more  than  one  county 
society  exists,  friendly  overtures  and  concessions  shall  be 
made,  with  the  aid  of  the  Councilor  for  the  District  if 
necessary,  and  all  of  the  members  brought  into  one  organ- 
ization. In  case  of  failure  to  unite,  an  appeal  may  be 
made  to  the  Council,  which  shall  decide  what  action 
shall  be  taken. 

SEC.  5.  Each  county  society  shall  judge  of  the  quali- 
fications of  its  own  members;  but,  as  such  societies  are 
the  only  portals  to  this  Society  and  to  the 
American  Medical  Association,  every  reputable  and 
legally  registered  physician,  who  does  not  practice  or 
claim  to  practice,  nor  lend  his  support  to  any  exclusive 
system  of  medicine,  shall  be  eligible  to  membership.  No 
physician  or  surgeon  who  solicits  patients  or  business  for 
himself  or  for  an  association  or  other  organization  of 
which  he  is  a member,  or  by  which  he  is  employed,  or  in 
which  he  is  interested,  shall  be  eligible  for  membership 
in  this  Society;  and  no  physician  or  surgeon  who  works 
for,  is  employed  by,  or  is  interested  in,  any  association 
or  organization  which  solicits  patients,  members  or  busi- 
ness shall  be  eligible  for  membership  in  this  Society.  Any 
member  of  this  Society  who  shall  hereafter  violate  any  of 
the  provisions  hereof  shall  be  expelled  from  the  Society. 
Before  a charter  is  issued  to  any  county  society,  full  and 
ample  notice  and  opportunity  shall  be  given  to  every 
such  physician  in  the  county  to  become  a member. 

SEC.  6.  Any  physician  who  may  feel  aggrieved  by  the 
action  of  the  society  of  his  county  in  refusing  him  mem- 
bership, or  in  censoring,  suspending,  or  expelling  him,  shall 
have  the  right  to  appeal  to  the  Council,  and  its  decision 
shall  be  final.  A county  society  shall  at  all  times  be 


permitted  to  appeal  or  refer  questions  involving  member- 
ship to  the  Council  of  the  State  Society  for  final  deter- 
mination. That  the  Council  may  be  aided  in  rendering 
just  decisions,  it  is  necessary  that  the  By-Laws  of  each 
component  society  provide  in  detail  the  routine  to  be  fol- 
lowed in  preferring  charges  and  trying  any  member  ac- 
cused of  and  tried  for  any  kind  of  unprofessional  con- 
duct. 

SEC.  7.  In  hearing  appeals  the  Council  may  admit 
oral  or  written  evidence  as  in  its  judgment  will  best  and 
most  fairly  present  the  facts;  but  in  case  of  every  appeal, 
both  as  a Board  and  as  individual  Councilors  in  district 
and  county  work,  efforts  at  conciliation  and  compromise 
shall  precede  all  such  hearings. 

SEC.  8.  When  a member  in  good  standing  in  a com- 
ponent county  society  moves  to  another  county  in  this 
State,  he  shall  be  given  a written  certificate  of  thesa 
facts  by  the  Secretary  of  his  society,  without  cost,  for 
transmission  to  the  Secretary  of  the  society  in  the  county 
to  which  he  moves.  Pending  his  acceptance  or  rejection 
by  the  society  in  the  county  to  which  he  moves  such 
member  shall  be  considered  to  be  in  good  standing  in 
the  county  society  from  which  he  was  certified  and  in 
the  State  Society  to  the  end  of  the  period  for  which 
his  dues  have  been  paid. 

SEC.  9.  A physician  living  near  a county  line  may 
hold  his  membership  in  that  county  most  convenient  for 
him  to  attend,  on  permission  of  the  component  society 
in  whose  jurisdiction  he  resides. 

SEC.  10.  Each  component  society  shall  have  general 
direction  of  the  affairs  of  the  profession  in  its  county, 
and  its  influence  shall  be  constantly  exerted  for  bettering 
the  scientific,  moral  and  material  condition  of  ever\ 
physician  in  the  county;  and  systematic  efforts  shall  be 
made  by  each  member,  and  by  the  society  as  a whole, 
to  increase  the  membership  until  it  embraces  every  quali- 
fied physician  in  the  county. 

SEC.  II.  At  some  meeting  in  advance  of  the  Annual 
Session  of  this  Society,  each  county  shall  elect  a delegate 
or  delegates  to  represent  it  in  the  House  of  Delegates 
of  this  Society,  in  the  proportion  of  one  delegate  to  each 
twenty-five  members,  and  one  for  each  major  fraction 
thereof,  and  the  Secretary  of  the  county  society  shall 
send  a list  of  such  delegates  to  the  Secretary  of  this 
Society  at  least  ten  days  before  the  Annual  Session. 

SEC.  12.  The  Secretary  of  each  component  society 
shall  keep  a roster  of  its  members,  and  of  the  non- 
affiliated  registered  physicians  of  the  county,  in  which 
shall  be  shown  the  full  name,  address,  college  and  date 
of  graduation,  date  of  license  to  practice  in  this  state, 
and  such  other  information  as  may  be  deemed  neces- 
sary. In  keeping  such  roster  the  Secretary  shall  note 
any  changes  in  the  personnel  of  the  profession  by  death, 
or  by  removal  to  or  from  the  county,  and  in  making 
his  annual  report  he  shall  endeavor  to  account  for  every 
physician  who  has  lived  in  the  county  during  the  year. 

SEC.  13.  The  Secretary  of  each  component  society 
shall  forward  its  assessment,  together  with  its  roster  of 
officers  and  members,  list  of  delegates,  and  list  of  non- 
affiliated  physicians  of  the  county,  to  the  Secretary  of 
this  Society  on  January  I,  and  not  later  than  March  I of 
each  year. 

SEC.  14.  Any  county  society  which  fails  to  pay  its 
assessment,  or  make  the  report  required,  on  or  before 
March  I,  shall  be  held  as  suspended,  and  none  of  its 
members  or  delegates  shall  be  permitted  to  participate 
in  any  of  the  business  or  proceedings  of  the  Society  or 


February,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


159 


of  the  House  of  Delegates  until  such  requirements  have 
been  met. 

CHAPTER  X.— MISCELLANEOUS 

SECTION  I.  No  address  or  paper  before  the  Society, 
except  those  of  the  President  and  orators,  shall  occupy 
more  than  twenty  minutes  in  its  delivery,  and  no  member 
shall  speak  longer  than  five  minutes  nor  more  than  once 
on  any  subject,  except  by  unanimous  consent. 

SEC.  2.  All  papers  read  before  the  Society  or  any 
of  the  Sections  shall  become  its  property.  Each  paper 
shall  be  deposited  with  the  Secretary  when  read. 

SEC.  3.  The  deliberations  of  this  Society  shall  be  gov- 
erned by  parliamentary  usage  as  contained  in  Roberts' 
Rules  of  Order,  when  not  in  conflict  with  this  Constitu- 
tion and  By-Laws. 

SEC.  4.  The  Principles  of  Medical  Ethics  promulgated 
by  the  American  Medical  Association  shall  govern  the 
conduct  of  members  in  their  relation  to  each  other  and 
to  the  public. 

CHAPTER  XI.— AMENDMENTS 

The  House  of  Delegates  may  amend  any  article  of  this 
Constitution  by  a two-thirds  vote  of  the  Delegates  present 
at  any  Annual  Session,  provided  that  each  amendment 
shall  have  been  presented  in  open  meeting  at  the  pre- 
vious Annual  Session,  and  that  it  shall  have  been  pub- 
lished twice  during  the  year  in  a bulletin  or  Journal  of 
this  Society,  or  sent  officially  to  each  component  society 
at  least  two  months  before  the  meeting  at  which  final 
action  is  to  be  taken. 

<S> 

EDITORIAL  COMMENT 

(Continued  from  Page  153) 

therein.  We  quote:  * * * * round-up  the  chil- 

dren for  examination  and  urge  the  parents  to 
take  them  to  the  family  physician  and  dentist  for 
further  advice  and  treatment."  Quoting  further, 
"It  should  be  clearly  understood  that  the  Con- 
gress does  not  advocate  free  medical  or  dental 
service  for  the  correction  of  defects,  but  refers 
the  child  to  the  family  physician  and  dentist  for 
treatment,  unless  it  is  found  necessary'  to  seek 
some  benevolent  agency  to  provide  the  service 
in  selected  cases."  The  desirability  of  individual 
attention  rather  than  the  haphazard  examina- 
tions conducted  under  the  many  difficulties  of 
the  group  clinic  has  received  much  attention  of 
late  from  lay  organizations  as  well  as  from  medi- 
cal societies.  It  has  been  discussed  in  The  Jour- 
nal by  Robins1  and  a similar  resolution  by  Bowie- 
Miller  County  Medical  Society  appears  in  this 
issue.  The  cooperation  of  all  county  medical 
societies  with  lay  organizations  interested  in 
health  activities  is  necessary  for  public  welfare 
but  it  is  the  right  of  medical  men  to  state  how 
these  examinations  should  be  conducted.  An 
insistence  for  examination  in  the  physician's  of- 


1  Robins,  R.  B.  The  Ouachita  County  Plan.  J.  Ark.  M. 
Soc.,  July  1934,  31,  35. 


fice  is  additional  argument  in  favor  of  the  pres- 
ent physician-patient  relationship  and  its  general 
adoption  will  react  to  the  advantage  of  organ- 
ized medicine. 


A list  of  physicians  not  now  members  but  ap- 
parently eligible  for  membership  has  been  fur- 
nished each  county  secretary  by  the  state  secre- 
tary. This  list  was  compiled  from  the  1934  Direc- 
tory of  the  American  Medical  Association  and 
shows  in  a striking  manner  just  what  increase 
in  membership  is  possible  for  the  Arkansas  Medi- 
cal Society  should  the  county  societies  aggres- 
sively seek  the  affiliation  of  these  non-members. 
A fifty  per  cent  increase  in  numerical  strength 
should  result  with  active  work  on  the  part  of 
county  society  membership  committees.  This 
does  not  imply  lowering  our  standards  in  any 
manner;  conversations  with  practically  all  county 
secretaries  having  well  established  the  fact  that 
there  are  many  non-members  worthy  and  eligible 
for  membership  in  organized  medicine.  Missis- 
sippi County  Medical  Society  through  its  secre- 
tary, F.  D.  Smith,  has  already  contacted  each 
eligible  physician  on  the  list  furnished  that  county 
and  expects  to  follow  up  this  first  contact  with 
personal  solicitations  to  insure  eventual  affilia- 
tion of  these  physicians.  Similar  efforts  are 
needed  in  the  other  county  societies.  If  each 
member  of  the  Arkansas  Medical  Society  would 
feel  a personal  responsibility  in  securing  new 
members  to  strengthen  the  organization,  an  all- 
time  high  for  membership  would  be  attained 
by  the  time  of  the  annual  meeting  in  April. 

The  New  Year  should  bring  to  the  minds  of 
each  member  of  the  county  medical  societies 
this  question:  "How  successful  a year  will  my 
society  have  this  year  and  what  can  I do  to  help 
make  it  successful?" 

County  medical  societies  are  the  basic  units  in 
medical  organization.  Upon  them  devolves  the 
duty  of  regulating  professional  affairs  in  their 
respective  counties.  Largely  will  public  opinion 
guage  the  character  of  the  medical  profession 
in  the  community  by  the  standards  held  by  the 
county  medical  society.  The  county  society  is 
most  important.  It  should  be  the  pleasure  of 
each  physician  to  fully  cooperate  in  making  his 
society  an  efficient  organization.  Unfailing  loy- 
alty is  the  rightful  demand  of  the  society  from 
its  members;  unfailing  service  from  the  society  is 
the  right  of  its  members. 


160 


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[Vol.  XXXI,  No.  9 


PROCEEDINGS  OF  SOCIETIES 


The  Ouachita  County  Medical  Society  was  ad- 
dressed at  its  January  3rd  meeting  by  Drs.  Paul 
Day,  A.  DeGroat,  W.  C.  Langston,  C.  H.  Mc- 
Donald, A.  E.  Pirnique  and  F.  Vinsonhaler,  of  the 
University  of  Arkansas  Medical  School  Faculty. 

Saline  County  Medical  Society  has  elected  the 
following  officers:  President,  E.  A.  Buckley,  Baux 
ite;  Vice-president,  T.  C.  Watson,  Benton,  and 
Secretary-treasurer,  C.  W.  Jones,  Benton.  J.  A. 
Burks  and  T.  C.  Watson  were  elected  delegate 
and  alternate  respectively. 

Miller  County  Medical  Society  has  elected  the 
following  officers:  President,  N.  B.  Daniel;  Vice- 
president,  L.  H.  Lanier;  Secretary-treasurer,  B. 
C.  Middleton;  Censor,  T.  F.  Kittrell;  Delegate, 
H.  E.  Murry;  Alternate,  A.  H.  Mann. 

Johnson  County  Medical  Society  has  elected 
the  following  officers:  President,  J.  M.  Kolb; 

Secretary-treasurer,  G.  R.  Siegel. 

Pulaski  County  Medical  Society  has  elected  as 
President  for  1935,  Joe  F.  Shuffield,  and  re-elect- 
ed E.  H.  White  and  R.  J.  Calcote,  Secretary  and 
Treasurer  respectively. 

Conway  County  Medical  Society  has  reor- 
ganized as  a separate  county  society  for  1935, 
electing  the  following  officers:  President,  J.  H. 
Colay,  Jerusalem;  Vice-president,  A.  L.  Goat- 
cher,  Plumerville,  and  Secretary-treasurer,  C.  E 
Etheridge,  Morrilton. 


Hempstead  County  Medical  Society  has  elect- 
ed the  following  officers:  President,  G.  E.  Can- 
non; Vice-president,  J.  H.  Weaver,  and  Secre- 
tary-treasurer, A.  C.  Kolb. 

Sebastian  County  Medical  Society  held  its  an- 
nual banquet  session  on  January  8th.  Talks  were 
made  by  I.  F.  Jones,  retiring  president;  F.  H. 
Krock,  incoming  president;  Earle  Hunt,  Clarks- 
ville; H.  Moulton,  M.  E.  Foster  and  J.  A.  Foltz. 
J.  H.  Buckley  acted  as  toastmaster. 

J.  W.  Amis,  Secretary. 

H.  Fay  H.  Jones,  Little  Rock,  addressed  the 
Medical  Association  of  the  Missouri  Pacific  Rail- 
road January  25th  at  New  Orleans  on  "Backache 
as  Observed  from  Urological  Viewpoint."  L.  J. 
Kosminsky,  Texarkana,  President  of  the  Associa- 
tion, addressed  the  annual  banquet  session. 


The  Fiffh  Councilor  District  Medical  Society 
met  in  banquet  session  at  El  Dorado  January  8th 
Officers  for  1935  were  elected  as  follows:  Presi- 
dent, J.  J.  Baker,  Magnolia;  Vice-president,  T.  H. 
Jones,  Magnolia,  and  Secretary-treasurer,  S.  A. 
Thompson,  Camden.  The  following  program  was 
presented:  "Pulmonary  Tuberculosis,"  J.  D.  Riley, 
State  Sanatorium;  "Some  Problems  of  the  New 
Born,"  A.  C.  Kirby,  Little  Rock;  "Fractures,"  W. 
V.  Newman,  Little  Rock,  and  "Physiology  of  Fer- 
tilization in  the  Human  Female,"  (motion  picture), 
E.  H.  White,  Little  Rock.  F.  O.  Mahony,  El  Do- 
rado, and  A.  S.  Buchanan,  Prescott,  addresesd 
the  meeting  on  legislative  matters  following  the 
scientific  program. 

D.  E.  White,  Secretary. 


Sevier  County  Medical  Society  has  elected  the 
following  officers:  President,  I.  G.  Jones;  Vice- 
president,  C.  E.  Kitchens,  and  Secretary-treas- 
urer, C.  C.  Hanchey. 


Faulkner  County  Medical  Society  has  elected 
the  following  officers:  President,  J.  H.  Downs, 
Vilonia;  Vice-president,  G.  L.  Henderson,  Con- 
way; Secretary-treasurer,  J.  S.  Westerfield,  Con- 
way. 


The  Lawrence  County  Medical  Society  met 
with  Dr.  J.  C.  Hughes  at  Hoxie  on  January  8th, 
installing  officers  for  1935  as  follows:  President, 
H.  R.  McCarroll,  Walnut  Ridge;  Vice-president, 
T.  C.  Neece,  Walnut  Ridge;  Secretary-treasurer, 
Chas.  D.  Tibbels,  Black  Rock;  and  Censor,  R.  S. 
Kendall,  Strawberry. 

Woodruff  County  Medical  Society  has  elected 
the  following  officers:  President,  R.  N.  Smith, 
Augusta;  Vice-president,  J.  W.  Morris,  McCrory, 
and  Secretary-treasurer,  L.  E.  Biles,  Augusta. 


Prairie  County  Medical  Society  has  elected  the 
following  officers:  President,  W.  J.  B.  Williams, 
Des  Arc;  Vice-president,  Edward  Adams,  De- 
Vall's  Bluff;  and  Secretary-treasurer,  J.  C.  Gil- 
liam, Des  Arc. 


H.  D.  Wood,  Fayetteville,  addressed  the 
Washington  County  Medical  Society  January 
8th  on  "The  Ethics  of  Consultation."  This  was 
the  88th  birthday  of  the  speaker  who  is  the  old- 
est physician  in  active  practice  in  the  United 
States,  and  the  only  living  charter  member  of 
the  Washington  County  and  Arkansas  Medical 
Societies. 


February,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


161! 


Phillips  County  Medical  Society  has  elected 
the  following  officers:  President,  J.  B.  Ellis;  Vice- 
president,  H.  H.  Rightor;  and  Secretary-treas- 
urer, A.  W.  Cox. 


The  January  4th  meeting  of  the  Crittenden 
County  Medical  Society  was  devoted  to  a con- 
sideration of  legislation  affecting  public  health 
and  the  medical  profession.  The  meeting  was 
addressed  by  Drs.  L.  C.  McVay,  who  spoke  on 
medical  insurance  and  socialized  medicine;  J.  O. 
Rush,  J.  L.  Jelks,  A.  M.  Washburn  and  W.  B. 
Grayson,  and  the  following  members  of  the  legis- 
lature, Harve  Thorne,  Wilks  and  E.  C.  Gathings. 
The  society  has  elected  the  following  officers 
for  1935:  President,  T.  S.  Hare,  Crawfordsville; 
Vice-president,  R.  H.  Ray,  Earl;  and  Secretary- 
treasurer,  L.  C.  McVay,  Marion. 

<S> 

PERSONALS  AND  NEWS  ITEMS 


"Medicine  Applied  to  Business,"  by  A.  S. 
Buchanan,  Prescott,  appears  in  the  December 
Tri-State  Medical  Journal. 

Dr.  H.  A.  Dishongh  has  been  appointed 
deputy  coroner  for  Pulaski  County. 

R.  L.  Fraser  has  been  elected  Historian  of  the 
McCrory  Post  of  the  American  Legion. 

Dr.  Harvey  S.  Thatcher,  Little  Rock,  has  been 
appointed  the  member  of  the  Council  of  the 
Southern  Medical  Association  from  Arkansas  for 
a regular  Council  term  of  five  years,  the  ap- 
pointment having  been  announced  recently  by 
the  President,  Dr.  H.  Marshall  Taylor  of  Jack- 
sonville, Florida.  Dr.  Thatcher  succeeds  Dr.  Mor- 
gan Smith.  Little  Rock,  who,  having  served  the 
constitutional  limit,  was  not  eligible  for  reap- 
pointment. 

C.  A.  Henry,  Clarendon,  has  been  appointed 
director  of  the  Saline  County  Health  Depart- 
ment, succeeding  T.  C.  Watson,  who  returns  to 
private  practice. 

James  K.  Grace  has  resigned  as  Surgeon,  C. 
C.  C.  Camp,  Mount  Nebo,  and  has  returned  to 
private  practice  at  Belleville. 

R.  H.  Huntington  has  been  elected  Scribe  of 
the  Eureka  Springs  chapter,  Royal  Arch  Masons. 

I.  R.  Johnson,  Blytheville,  has  established  a 
laboratory  in  connection  with  his  office  with  a 
technician  in  charge. 


C.  B.  Capel,  Pine  Bluff,  entertained  at  a veni- 
son dinner  on  December  14th  for  Pine  Bluff  phy- 
sicians, their  wives,  the  nurses  of  the  city,  and 
members  of  the  board,  staff  and  auxiliary  of 
Davis  Hospital. 

C.  D.  Winborn,  formerly  of  Dallas,  has  asso- 
ciated himself  with  J.  G.  Mitchell  at  El  Dorado.. 


S.  M.  Self,  Walcott,  lost  his  office  and  fix- 
tures by  fire  on  December  2nd. 

J.  C.  Miller,  Malvern,  entertained  the  follow- 
ing physicians  of  that  city  at  dinner  December- 
27th:  E.  H.  McCray,  W.  F.  Barrier,  W.  G- 

Hodges,  H.  L.  Brown,  J.  M.  Williams,  and  E.  T.. 
Bramlitt. 


J.  T.  Altman,  Jonesboro,  addressed  the  Craig- 
head County  Bar  Association  December  28th. 

Dr.  and  Mrs.  D.  E.  Evans,  Harrison,  celebrated 
their  54th  wedding  anniversary  December  23rd. 

W.  B.  Bruce,  Helena,  has  been  elected  Chair- 
man of  the  Eastern  Arkansas  Park  Association. 


Drs.  E.  D.  McKnight,  Brinkley,  and  L.  D.  Dun- 
can, Waldron,  have  been  re-appointed  to  the 
State  Board  of  Health  for  four-year  terms. 

Byron  L.  Robinson  and  W.  C.  Langston,  of 
the  University  of  Arkansas  Medical  School  facul- 
ty, received  third  award  in  the  Scientific  Ex- 
hibit of  the  Southern  Medical  Association  for 
their  exhibit  on  castration  atrophy  and  theelin. 

Newly-appointed  county  health  officers  are: 
W.  P.  Scarlett,  for  Monroe  County,  and  J.  Kent 
Grace,  for  Yell  County. 

W.  E.  Gray,  formerly  with  Drs.  Rhinehart,  has 
located  in  Hot  Springs  National  Park,  where  he 
will  take  over  the  office  of  the  late  Dr.  W.  L. 
Snider. 


R.  R.  Kirkpatrick,  Texarkana,  has  been  elect- 
ed President  of  the  Michael  Meagher  Hospital 
staff. 


Earle  Hunt  addressed  the  Johnson  County 
Medical  Society  December  26th  on  "Empyema." 

J.  E.  Neighbors,  Stuttgart,  suffered  flesh 
wounds  of  the  chest  and  left  arm  by  the  acci- 
dental discharge  of  his  shotgun  on  January  I2tfu 


162 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  9 


C.  S.  Holt,  Fort  Smith,  spent  a vacation  in 
New  Orleans  and  Memphis  during  January. 

E.  L.  Matthews  acted  as  Chairman  of  the  Mor- 
rilton  Roosevelt  Ball. 


Drs.  G.  A.  Hebert,  C.  H.  Lutterloh  and  D.  B. 
Stough  of  Hot  Springs  National  Park,  and  C.  W. 
Jones,  Benton,  attended  the  Centennial  Clinics 
of  Tulane  University  in  December. 

Ralph  Sloan,  Jonesboro,  addressed  the  Green 
County  Medical  Society  at  Paragould  January 
I Oth. 


"The  Spa  Treatment  of  Arthritis"  by  M.  F. 
Lautman,  Hot  Springs  National  Park,  appeared 
in  the  January  issue  of  Southern  Medicine  and 
Surgery. 

<S> 

RESOLUTION 


Whereas,  God  in  His  infinite  wisdom  has  suddenly 
snatched  from  our  midst  our  friend  and  colleague,  Dr. 
W.  L.  Snider;  and 

Whereas,  Dr.  Snider  was  endeared  to  us  by  his  genial 
personality,  his  kindliness,  and  charitable  nature.  Not 
only  did  his  traits  of  character  appeal  to  us  and  make  us 
desire  to  emulate  them,  but  we  shall  ever  remember 
his  technical  skill  and  mechanical  genius.  The  technical 
beauty  of  his  X-ray  films  were  a revelation  to  all  who  saw 
them  and  men  in  his  line  envied  that  skill  which  many 
strive  for  but  few  attain.  Before  the  World  War,  Dr. 
Snider's  good  work  in  his  chosen  line  was  recognized, 
but  during  the  war,  there  was  a steady  growth  in  his 
technical  skill.  The  teaching  was  easily  absorbed,  to  be- 
come a part  of  him,  broadening  him  in  every  aspect  and 
making  of  him  one  of  the  best  experts  in  the  Southwest. 
Dr.  Snider  once  told  one  of  his  colleagues  that  he  was 
a much  better  X-ray  man  after  the  war  and  when  asked 
in  what  respect,  he  said,  "In  ability  to  correctly  inter- 
pret." This  power  of  interpretation,  he  made  available 
to  our  profession  through  the  years  and  it  is  to  us  a 
profound  source  of  regret  that  we  no  longer  have  that 
aid,  and 

Therefore,  Be  it  resolved,  that  the  Garland  County-Hot 
Springs  Medical  Society  in  session  assembled  express 
our  appreciation  for  the  noble  work  that  Dr.  Snider  has 
done  among  us;  that  we,  as  a Society  feel  a sense  of 
personal  loss  at  his  death  and  shall  ever  cherish  his 
memory;  and  that  we  recommend  to  the  members  of  the 
Society  that  they  follow  the  high  technical  and  ethical 
standards  which  Dr.  Snider  unfailingly  followed;  and 

Be  it  further  resolved  that  we  express  our  sympathy 
to  Mrs.  Snider  for  her  irreparable  loss;  and  that  a copy 
of  this  resolution  be  sent  to  Mrs.  Snider  and  to  Dr. 
Snider's  father  and  Dr.  William  V.  Laws;  that  a copy 
be  spread  on  the  minutes  of  the  Society  and  that  a copy 
be  sent  to  the  press. 


OBITUARY 


WARREN  LAWS  SNIDER,  aged  56,  died  sud- 
denly at  his  home  in  Hot  Springs  National  Park 
December  12th  following  a heart  attack.  He 
was  born  in  Fairland,  Indiana,  on  March  18, 
1878,  and  graduated  from  the  Medico-Chirurgi- 
cal  College  of  Pennsylvania  in  1902.  He  located 
in  Hot  Springs  National  Park  in  1911  and  had 
devoted  himself  to  roentgenology  since  that 
time.  He  served  during  the  World  War.  Sur- 
viving him  are  his  wife,  his  father,  Dr.  J.  W. 
Snider,  an  uncle,  Dr.  W.  V.  Laws,  also  of  Hot 
Springs  National  Park,  and  a brother. 

WILLIAM  HUNT  BLANKENSHIP,  aged  68, 
died  at  his  home  in  Pine  Bluff  December  12th 
after  an  illness  of  several  weeks.  He  was  born 
in  Louisiana  in  1866  and  graduated  from  the 
College  of  Physicians  and  Surgeons  in  Baltimore 
in  1893.  Of  his  43  years  in  the  practice  of 
medicine,  the  last  13  were  spent  in  Pine  Bluff. 
He  is  survived  by  his  wife,  four  daughters  and 
three  sons. 


FRANK  E.  HURRLE,  Little  Rock,  aged  54, 
died  January  14th  of  injuries  sustained  in  an 
automobile  accident  on  January  I Ith.  Born  in 
Louisville,  Kentucky,  January  14,  1881,  Dr.  Hurrle 
attended  a pharmacy  school  following  comple- 
tion of  his  high  school  course.  He  came  to  Pine 
Bluff  to  manage  a drug  store  but  later  entered 
the  School  of  Medicine  of  the  University  of  Ark- 
ansas, graduating  in  1911.  He  was  a member  of 
the  Pulaski  County  and  the  Arkansas  Medical  So- 
cieties, St.  Andrews  Cathedral,  Knights  of  Co- 
lumbus, the  Catholic  Knights  of  America,  F.  O. 
Eagles  and  Modern  Woodmen  of  America.  He 
married  Miss  Virginia  Walker  of  Pine  Bluff  in 
1918,  who  survives  him.  Other  surviving  rela- 
tives are  his  mother,  three  sisters  and  a brother. 


COMING  MEDICAL  MEETINGS 

Mid-South  Post  Graduate  Medical  Assembly, 
Memphis,  February  I 2- 1 5th. 

American  College  of  Surgeons,  (District),  Kan- 
sas City,  March  I 2- 1 3th. 

Dallas  Southern  Clinical  Society,  Dallas,  March 
I 8th-22nd. 

Arkansas  Medical  Society,  Fort  Smith,  April 
I 5- 1 7th. 


February,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


163 


DOCTORS,  AS  HUSBANDS* 


'Though  my  talk  should  be  humorous 
I know  you'll  agree 
That  a serious  subject 
Was  given  to  me. 

For  who  marries  a Doctor 
And  is  a true  wife, 

Must  join  the  Profession, 

And  serve  it  for  Life. 

She  must  learn  to  be  friendly 
When  answering  the  phone; 

Take  down  the  right  numbers 
When  the  Doctor's  not  home. 

If  a voice,  in  a frenzy, 

Cries,  "Get  him,  quick,  please, 

For  my  baby  has  just 
Developed  a sneeze." 

She  must  soothe  her,  and  calm  her, 
For  woe  will  befall, 

If  she  can't  locate  her  husband 
And  give  him  the  call. 


She  must  never  be  tired 
Or  tell  what  has  gone  wrong; 
He's  heard  fool  women  whine 
The  whole  day  long. 

Then — if  one  of  the  children 
Breaks  out  in  a rash; 

It's  "Measles  or  Smallpox," 

He  cries,  quick  as  a flash. 

To  his  wife's  anxious  questions 
He  gruffly  replies, 

"She  must  be  kept  quiet, 

So  humor  her  cries. 

"Call  the  Doctor  at  once; 

No,  call  two  or  three. 

We'll  have  consultation 
As  soon  as  can  be. 

it  may  not  be  fatal; 

It's  too  early  to  tell; 

But  if  pneumonia  sets  in, 

She  just  can't  get  well." 


His  patient  will  tell  her 
How  wonderfully  kind, 

How  sympathetic,  he  is, 

And  how  cheerful,  they  find. 


So,  instead  of  one  patient, 
The  wife  nurses  two — 

Her  child,  and  her  husband- 
Now,  isn't  this  true? 


When  he  enters  the  sick-room, 

Improvement,  they  show; 

He  says  not  to  worry 
If  recovery  is  slow. 

That  already  they're  better, 

And  he'll  do  his  best 
If  they  will  be  patient 
And  keep  on  with  their  rest. 

But — if  this  same  Doctor, 

As  a Husband,  comes  home 
And  finds  his  wife  ill — - 
Oh,  my,  what  a moan. 

A pucker  of  worry, 

An  impatient  tone: 

"You've  been  doing  too  many  things 
Outside  of  your  home. 

"Stay  in  bed — just  be  quiet — 

Let  things  slide  and  go  slow;" 

Then  off  to  a meeting 
He  hastens  to  go. 

She  recalls  how  his  patients 
His  virtues  relate, 

But  she  finds,  as  a Husband, 

He  wants  no  complaint. 

If  she  follows  directions, 

Quite  soon  she  will  find 
That  he  didn't  expect  her 
His  orders  to  mind. 

He's  tired  of  the  sickroom 
And  hospital  sights; 

He  wants  order  and  cheer 
When  he  comes  home  nights. 

* Given  before  Ladies'  Night,  Fort  Smith  Clinical  So- 
ciety, November  22,  1934. 


He  may  be  a Specialist 
Working  hours  at  a spell 
Sorting  stamps,  new  and  old, 

I know  one  such,  quite  well. 

If  I say,  "Let's  play  bridge, 

Shall  I phone  anyone?" 

He  replies,  "I'm  too  tired," 

But  the  sorting  goes  on. 

"See  this  stamp?  It's  unusual, 
There  are  but  few  of  its  kind; 

I got  this  from  a patient, 

It's  really  a find." 

It  may  be  your  husband 
At  fishing,  ranks  high, 

And  is  a fine  Specialist 
At  casting  a fly. 

Off  for  week-ends  he  goes, 

With  two  or  three  men, 

Wades  miles,  in  huge  boots, 
Through  the  swift  water,  and  then 

Thinks  nothing  of  rowing 
A heavy  boat  up  the  stream — 

But  work  around  home 
Is  too  tiring  for  him. 

Your  kind  of  Doctor 
I may  now  have  in  mind; 

The  one  who  chooses  golf 
For  his  specialty  line. 

If  the  weather  is  bad 
Or  he's  off  of  his  game 
It's  up  to  his  wife 
To  cheer  him  again. 


164 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  9 


He  plays  every  Sunday 
And  holidays,  too; 

But  he's  too  busy  to  picnic 
With  the  children,  and  you. 

If  we're  asked  out  to  dinner, 

We  must  often  say  "No — 

It's  Staff  meeting  night — 

Doctor  feels  he  should  go." 

There  you  are — Doctor  Husbands — - 
As  Doctors,  you'll  do; 

But  as  Husbands — that's  different, 

As  I've  proven  to  you. 

Since  we’ve  chosen  to  marry 
Professional  men; 

We'll  make  of  our  bargain, 

The  best  that  we  can. 

We’ll  share  you  with  your  patients 
And  your  Specialties,  too; 

For  we're  proud  to  serve 
The  Profession,  with  you. 

— Juliette  G.  Moulton. 

MJXIUARY  NEWS 


"THE  MODERN  DOCTOR" 

I visited  a Modern  Doctor  one  day 
To  ask  him  my  various  pains  to  allay, 

He  thumped  on  me  here,  and  beat  on  me  there 

Till  I thought  I'd  be  blue,  from  my  heels  to  my  hair. 

Then  numerous  questions,  he  began  to  propound 
To  see  if  the  reason  for  why  could  be  found. 

Talk  about  manners,  that  Doctor  sure  had  ’em 

He  asked  the  health  of  my  relatives,  way  back  to  Adam. 

He  said,  "Do  you  eat  eggs,  potatoes  and  fish?" 

I answered  yes,  just  as  much  as  I wish. 

How  about  spinach,  ice  cream  and  fresh  meat? 

Sure  do,  said  I,  and  think  them  a treat. 

Well,  do  you  motor,  swim,  or  play  golf? 

Yes,  all  of  them,  every  moment  I'm  off. 

Then  he  felt  of  my  pulse,  and  gazed  at  my  tongue, 

And  so,  lookin'  wise,  did  say  what  was  wrong. 

Your  trouble,  said  he,  I plainly  can  see, 

It's  what  you  do  do,  with  you  don't  agree. 

So  quit  what  you  do  do,  and  do  what  you  don't. 

For  what  you  don't  may  agree,  as  what  you  do  do,  wont. 

— Mrs.  E.  A.  Hawley,  Texarkana,  Arkansas. 

The  Obstetrical  Pack  Committee  of  the  Woman's  Auxil- 
iary to  the  Pulaski  County  Medical  Society  met  at  the 
home  of  Mrs.  B.  A.  Bennett  December  4th.  Those  present 
were  Mrs.  J.  B.  Crawford,  president  of  the  auxiliary;  Mrs. 
Anderson  Watkins,  chairman  of  the  committee;  Mrs.  F.  E. 
Hurrle,  Mrs.  C.  C.  Reed,  Mrs.  W.  H.  Miller,  Mrs.  H.  A. 
Higgins  and  Mrs.  George  Jackson.  Material  was  pre- 
pared for  15  kits.  Refreshments  were  served  by  Mrs. 
Bennett,  asisted  by  her  mother,  Mrs.  Armstrong. 

The  semi-annual  meeting  of  the  auxiliary  of  the  Ninth 
Councilor  District  met  December  4th  at  the  home  of  Mrs. 
D.  L.  Owens,  of  Harrison,  with  Mrs.  Owens  and  Mrs.  J. 
H.  Fowler  as  joint  hostesses. 

A very  interesting  program,  consisting  of  readings, 


musical  numbers  and  a tap  dance,  was  rendered.  During 
the  business  meeting  thirteen  members  paid  dues.  A 
salad  plate  was  served  by  the  hostesses. 

Mrs.  A.  L.  Carter,  Pres. 

Mrs.  J.  H.  Bohannan,  Sec’y. 

The  Woman's  Auxiliary  to  the  Sebastian  County  Med- 
ical Society  met  January  14th  at  the  home  of  Mrs.  W.  R. 
Brooksher,  Jr.,  Fort  Smith.  Reports  were  heard  from  all 
committees  and  plans  for  the  work  during  the  year  were 
discussed.  Plans  were  outlined  for  the  coming  state  con- 
vention and  the  following  committees  were  appointed  by 
the  president,  Mrs.  Eugene  Stevenson:  General  Chairman 
— Mrs.  W.  R.  Brooksher,  Jr.;  Entertainment,  Mrs.  M.  E. 
Foster;  Decoration,  Mrs.  A.  F.  Hoge;  Luncheon,  Mes- 
dames  E.  C.  Moulton,  Pierre  Redman,  and  C.  S.  Holt; 
Tea,  Mesdames  S.  J.  Wolfermann,  J.  A.  Foltz  and  J.  C. 
Amis;  Program,  Mesdames  D.  W.  Goldstein  and  A.  A. 
Blair;  Publicity,  Mrs.  Walter  G.  Eberle;  Transportation, 
Mrs.  W.  F.  Rose;  Courtesy,  Mesdames  I.  F.  Jones,  J.  S. 
Southard,  A.  S.  Chapman,  B.  B.  Bruce,  H.  W.  Savery  and 
F.  H.  Krock;  and  Registration  and  Credentials,  Mesdames 
B.  W.  Freer,  S.  P.  Stubbs,  C.  S.  Bungart  and  G.  G.  Woods. 
Mrs.  C.  S.  Holt  and  Mrs.  F.  H.  Krock  invited  the  mem- 
bers of  the  Auxiliary  and  their  husbands  to  a party  to 
be  held  in  February.  Mrs.  H.  H.  Smith  was  accepted  as 
a new  member.  The  meeting  was  a most  interesting  one, 
every  active  member  with  the  exception  of  two  who 
were  out  of  town  being  present  for  the  meting.  Refresh- 
ments were  served  after  the  business  session. 


The  following  committee  from  the  Woman's  Auxiliary  to 
the  Sebastian  County  Medical  Society  served  on  the 
President's  Ball  Committee:  Mesdames  W.  R.  Brooksher, 
Jr.,  W.  F.  Rose,  S.  J.  Wolfermann,  A.  F.  Hoge,  W.  G. 
Eberle,  D.  W.  Goldstein  and  Pierre  Redman. 

BOOK  REVIEWS 


Medicine  Marches  On.  By  Edward  Podolsky,  M.  D. 
Pp.  373.  Price  $3.50.  New  York:  Harper  and  Brothers, 
1934. 

The  author  dramatically  recounts  recent  advances  in 
the  treatment  of  disease.  Some  statements  regarding 
new  discoveries  are  too  positive  and  perhaps  add  to  the 
marvels  of  medicine  in  an  unwarranted  degree.  The  book 
is  written  for  the  non-medical  reader  but  will  prove  en- 
tertaining to  the  physician. 


Clinical  Laboratory  Methods.  By  Pauline  S.  Dimmitt, 
Ph.  G.,  Medical  Technician  for  the  Stout  Clinic,  Sherman, 
Texas.  Pp.  148  with  36  illustrations  and  7 colored  plates. 
Price  $2.00.  Philadelphia:  F.  A.  Davis  Company,  1934. 

This  book  was  brought  out  after  years  of  work  in 
clinical  laboratories  and  from  experience  as  an  instruc- 
tor in  medical  biological  chemistry.  The  volume  is  an 
interesting  and  concise  account  of  all  the  latest  approved 
laboratory  procedures.  Marked  simplicity  of  material 
enables  students  and  technicians  to  carry  out  the  work 
in  a scientific  way,  emphasizing  accurate  and  reliable 
agents.  The  36  illustrations  and  the  7 colored  plates 
are  very  helpful  in  giving  the  student  a better  picture  of 
the  methods  and  results.  Here,  at  least,  is  one  book 
that  a student  can  study  from  front  to  back  without 
having  to  skip  chapters  to  avoid  confusion. 


1934  Year  Book  of  Radiology.  Edited  by  Charles  A. 
Waters,  M.  D.,  and  Ira  I.  Kaplan,  M.  D.  Pp.  512.  454 


February,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


165 


illustrations.  Price  $4.00.  Chicago:  The  Year  Book  Pub- 
lishers, 1934. 

That  the  publishers  should  elect  to  continue  this  valu- 
able volume  in  times  of  economic  unrest  is  appreciated 
by  those  who  have  access  to  the  preceding  years'  is- 
sues, but  that  it  should  appear  with  a price  reduction 
revives  one's  belief  in  the  goodness  of  mankind  and  in 
book  publishers  particularly.  This  volume  is  an  indis- 
pensable work  of  reference  to  all  radiologists,  a handy 
desk  companion.  All  literature  for  the  current  year  of 
interest  and  merit  has  been  capably  abstracted.  The 
use  of  454  illustrations  in  its  512  pages  is  an  index  of 
the  extent  to  which  the  abstracts  are  pictorially  pre- 
sented. The  diligence  of  the  editors  in  its  compilation 
excites  our  highest  admiration. 


The  Heart  Visible:  A Clin  ical  Study  in  Cardiovascular 
Roentgenology  in  Health  and  Disease.  By  J.  Polevski, 
M.D.,  Attending  Physician  and  Cardiologist,  Newark  Beth 
Israel  Hospital.  Pp.  208.  Price  $5.00.  F.  A.  Davis  Com- 
pany, Philadelphia,  1934. 

The  author  thoroughly  discusses  cardiac  visualization 
in  this  monograph,  stressing  the  importance  of  floros- 
copic  visualization.  The  book  is  directed  to  both  the 
clinician  and  the  roentgenologist;  the  former,  in  an  en- 
deavor to  familiarize  him  with  the  roentgen-ray  aid 
that  he  may  obtain  in  his  studies;  to  the  latter,  in  an 
endeavor  to  enable  him  to  observe  roentgenologically 
those  phenomena  which  the  clinician  has  elicited  by  other 
methods.  The  technical  factors,  the  normal  heart,  the 


abnormal  heart,  the  pericardium  and  the  great  vessels 
are  presented  in  authoritative  detail.  Written  in  lucid 
style  with  122  illustrations,  the  volume  is  a veritable  atlas 
on  the  subject.  It  is  an  indispensable  text  for  the  roent- 
genologist and  the  clinician  who  are  called  upon  to  inter- 
pret cardiac  signs  and  symptoms. 


A Manual  of  the  Practice  of  Medicine:  By  A.  A. 

Stevens,  A.M.,  M.D.,  formerly  Professor  of  Applied  Thera- 
peutics in  the  University  of  Pennsylvania;  Honorary  Con- 
sulting Physician  to  the  Philadelphia  General  Hospital; 
Consulting  Physician  to  St.  Agnes  Hospital,  Philadelphia. 
Thirteenth  Edition,  Revised.  685  pages.  Philadelphia  and 
London:  W.  B.  Saunders  Company,  1934.  Cloth,  $3.50 
net. 

This  book  has  been  in  use  since  1892  and  the  fact  that 
this  is  the  thirteenth  edition  is  sufficient  evidence  that 
it  is  of  value  to  students  and  practitioners.  It  is  not  a 
complete  digest  of  medical  practice  but  epitomizes  symp- 
toms, diagnosis  and  treatment  of  the  conditions  met  by 
the  average  physician.  Considerable  new  matter  ap- 
pears in  this  revision  including  massive  collapse  of  the 
lung,  psittacosis,  hyperinsulism  and  agranulocytic  angina. 
It  is  a convenient  reference  volume  with  the  attributes 
of  simplicity  and  brevity,  a valuable  book  for  the  busy 
physician  or  for  the  medical  student. 


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DURATION  of  EDEMA 

as  influenced  by  Hygroscopic  Agents 

«nPHE  edema  produced  by  the 
X smoke  solution  from  the  un- 
treated cigarette  lasted  an  average 
of  31  minutes  (8  to  82);  that  from 
the  diethylene-glycol  lasted  8 min- 
utes (0  to  2l);  and  that  with  the 
glycerine  lasted  45  minutes  (l  7 
to  122).” 

” Influence  of  Hygroscopic  Agents  Ht 
on  Irritation  from  Cigarette  Smoke.” 

— Proc.  Soc.  Exp.  Biol,  and  Med.,  1934, 
32,  241-245. 


.. 

Philip  Morris  cigarettes,  use  only 
diethylene-glycol,  as  the  hygroscopic 
agent.  To  any  doctor  who  wishes  to 
test  them  for  himself  the  Philip  Morris 
will  gladly  mail  a sufficient 

* * 


THE  COUNCIL  URG 


THE  JOURNAL 

^ of  the  ARKANSAS  MEDICAL  SOCIETY  ^ 

PUBLISHED  MONTHLY  UNDER  DIRECTION  OF  THE  COUNCIL 

Vol.  XXXI  FORT  SMITH,  ARKANSAS,  MARCH,  1935  No.  10 


THE  KNEE  JOINT* 

F.  WALTER  CARRUTHERS,  M.  D„  F.  A.  C.  S., 
Little  Rock. 


The  essayist  wishes  to  call  to  your  attention  a 
group  of  clinical  cases  that  are  in  a great  part 
responsible  for  the  acute  and  chronic  disabilities 
of  the  knee  joint. 

It  is  appalling,  though  none  the  less  true,  that 
many  lesions  of  the  knee  have  been  looked  upon 
as  medical  curiosities  because  they  have  not  been 
properly  recognized.  It  is  the  purpose  of  the 
essayist  to  consider  the  knee  in  a general  way 
from  the  anatomical,  functional  and  pathological 
sides  as  it  is  related  especially  to  the  so-called 
internal  derangements;  and  to  view  as  briefly  as 
possible  the  unusual  clinical  lesions  characterized 
by  loose  bodies,  osteochondritis  dissecans,  and 
the  more  common  types  of  synovitis,  both  acute 
and  chronic,  including  in  a minor  way,  tubercu- 
losis. 

An  internal  derangement  of  the  knee  as  de- 
scribed by  many  of  our  authorities  is  "A  me- 
chanical disorder  caused  by  a product  of  the 
joint  itself;  the  obstructed  tissue  may  be  the  re- 
sult of  either  traumatic  or  pathologic  process  and 
is  always  intra-articular." 

There  is  probably  no  bone  or  joint  condition 
which  presents  itself  to  the  surgeon,  internist  or 
specialist,  that  is  more  interesting  than  those  of 
the  knee  joint.  In  considering  the  knee,  let  us 
take  up  first  the  question  of  its  anatomy.  It  is 
a well-known  fact  that  the  knee  is  the  largest  and 
strongest  joint  in  the  body.  It  serves  two  dis- 
tinct purposes,  locomotion  and  weight  bearing. 
Its  strength  is  supplied  by  many  factors,  includ- 
ing the  large  ligaments  on  the  outer  side,  as  well 
as  its  many  delicate  and  intricate  parts,  known  as 
the  crucial  ligaments,  semilunar  cartilages  and  its 
large  synovial  membrane.  Its  internal  covering 
consists  of  a large  synovial  membrane,  which  is 
naturally  subjected  at  all  times  to  trauma  and 
disease. 

* Read  with  demonstration  of  cases  before  the  Fifty- 
ninth  annual  session  of  the  Arkansas  Medical  Society  held 
in  Little  Rock,  April  16-18,  1934. 


These  structures,  the  joint  capsule  with  its  sup- 
porting ligaments  and  tendons,  the  semilunar  car- 
tilages, the  femoral  articular  cartilage,  the  cru- 
cial ligaments,  the  tibial  spine,  the  synovial  mem- 
brane and  the  infrapatellar  fat-pad,  are  the  struc- 
tures involved  in  internal  derangements  of  the 
knee.  Together  they  make  up  a joint  remark- 
able for  its  combination  of  strength  with  range 
of  motion;  a combination  due  to  the  shape  of 
the  articulating  bones,  the  interposition  of  the 
semilunar  cartilages,  the  admirable  ligamentous 
protection  both  inside  and  out,  and  the  close 
apposition  of  hard  and  soft  structures  in  all  posi- 
tions of  the  joint,  a combination  giving  rise  to 
many  pathological  entities. 

Furthermore,  the  knee  joint,  because  it  is  a 
weight-bearing  joint,  because  it  has  a complicat- 
ed mechanism,  and  because  of  the  many  struc- 
tures that  are  subjected  to  trauma,  laceration 
and  rupture,  is  naturally  prone  to  injury,  entirely 
incapacitating,  and  very  often  difficult  to  repre- 
sent. 

The  pathological  situation,  aside  from  the  more 
or  less  rare  types  of  cystic  degeneration,  is  asso- 
ciated with  an  involvement  of  either  the  internal 
or  external  cartilages,  the  lesions  being  due  to 
injury  or  infection.  From  the  injury  standpoint 
are  those  that  result  in  tears,  fractures,  loosening 
or  even  complete  avulsion  of  one  or  more  of  the 
cartilages,  the  injury  resulting  in  the  "Bucket 
Handle"  fracture  (so-called  because  of  its  re- 
semblance to  the  old  English  leather  bucket),  or 
tears  of  one  of  the  cartilages.  Transverse  frac- 
tures are  also  commonly  noted.  The  bucket 
handle  fracture,  hyperimmobilization,  or  loose 
bodies  may  cause  marked  symptoms  and  should 
not  be  overlooked.  The  effect  on  the  joint  in 
recurrent  cases  is  the  inevitable  general  arthritic 
sequelae.  The  pathological  conditions  arising 
from  lesions  of  the  semilunar  cartilages,  loose 
bodies,  osteochondritis  dissecans,  osteophytis,  os- 
teochrondromatosis,  chondromalacia  of  the  pa- 
tella, the  acute  and  chronic  synovitises,  the  clas- 
sical Charcot's  joint  and  tuberculosis,  leave  lit- 
tle for  consideration. 


168 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  10 


CLINICAL  SYMPTOMS  AND  DIAGNOSIS 

The  symptoms  of  internal  derangements  of  the 
knee  are  chiefly  subjective  and  are  due  primarily 
to  mechanical  obstruction  and  secondarily  to  re- 
actions in  and  about  the  joint.  It  is  a well 
known  fact  that  in  many  instances  an  exact  diag- 
nosis is  impossible  without  first  operating  for  ex- 
plorative purposes.  Yet,  in  a general  way,  the 
symptoms  will  typify  the  mechanical  obstructive 
lesion  and  will  form  a basis  for  the  diagnosis. 

The  presence  of  fluid  in  the  knee  joint  should 
always  be  regarded  as  a serious  matter.  We 
know  that  injuries  to  the  knee  joint  are  very  fre- 
quent. Sir  Robert  Jones  has  reported  more  than 
two  thousand  cases  of  displacements  of  the  semi- 
lunar cartilage  alone,  operated  with  success, 
showing  the  frequency  of  this  condition  and  the 
advisability  of  surgical  intervention. 


FIG.  I 

Amount  of  flexion  following  a synovectomy  of  the 
knee. 

The  X-ray  diagnosis  of  knee  joint  conditions 
can  be  relied  upon  in  many  cases  but  the  history 
and  physical  findings  are  often  the  reliable  source 
of  your  final  diagnosis  and  conclusions. 

LESIONS  OF  THE  SEMILUNAR  CARTILAGE 

Lesions  of  the  semilunar  cartilage  occur  most 
frequently  among  young  active  adults,  with  a 
predisposing  trauma  which  may  be  severe  or 
even  insignificant.  About  70  per  cent  involve 
the  internal  semilunar  cartilage  and  about  30  per 
cent  involve  the  external  semilunar  cartilage. 
Those  involving  the  external  cartilage  usually  fol- 
low the  most  violent  form  of  injury.  However, 
at  a recent  meeting  in  this  country  where  the 
essayist,  Mr.  Naughton  Dunn  of  Birmingham, 
England,  called  our  attention  to  the  fact  that  in 
a series  of  250  cases  of  disturbances  in  the  carti- 


lages, both  internal  and  external,  171  involved 
the  internal  cartilage  and  79  the  external  carti- 
lage. He  cautioned  the  surgeon  doing  explora- 
tory operation  on  the  knee  not  to  overlook  ex- 
amination of  the  external  cartilage  as  unexpected 
disturbances  will  frequently  be  found. 

LOOSE  BODIES 

Loose  bodies,  or  the  so-called  "joint  mice,"  are 
sometimes  very  puzzling  but  are  readily  under- 
stood if  ail  their  physical  possibilities  are  kept 
in  mind.  They  may  lie  loosely  in  the  joint  and 
at  times  can  be  felt  on  palpation.  The  patient 
will  tell  you  that  he  can  feel  a mass  first  on  one 
side  then  on  the  other.  Again  a partially  de- 
tached fragment  may  lie  flush  with  the  articulat- 
ing surfaces  and  cause  practically  no  trouble,  it 
may  become  secondarily  attached  to  the  mem- 
brane lining.  The  history  will  show  a sudden  at- 
tack of  pain  usually  due  to  the  nipping  of  the 
body  between  the  articular  ends.  The  larger 
fragments  give  rise  to  less  acute  symptoms,  be- 
cause they  are  less  likely  to  engage  between  the 
articular  surfaces.  In  osteochrondromatosis,  ow- 
ing to  their  size,  the  bodies  become  caught  much 
more  frequently,  giving  rise  to  less  acute  symp- 
toms. The  difficulty  in  diagnosis  of  osteochron- 
dromatosis is  chiefly  in  the  early  cases  which  may 
simulate  a general  arthritic  involvement. 

Osteochrondromatosis  occurs  in  young  adults, 
generally  giving  a history  of  chronic  disability 
of  the  knee  with  locking,  abnormal  mobility  and 
swelling.  In  passing,  it  seems  hardly  necessary 
to  emphasize  the  importance  of  X-ray  examina- 
tion in  all  cases  involving  the  knee.  However,  do 
not  depend  too  much  upon  the  X-ray,  as  the  only 
change  that  may  be  noted  is  a narrowing  of  the 
joint  space  on  the  affected  side.  Air,  oxygen 
and  iodized  oil  injections  into  the  knee  joint  have 
been  described  by  many  authorities  as  an  aid  in 
diagnosis.  Such  technic  has  not  been  employed 
by  the  essayist. 

TUBERCULOSIS 

In  tuberculosis  of  the  knee,  age  is  the  para- 
mount point  for  consideration.  In  childhood  tu- 
berculosis of  the  knee  little  need  be  said  other 
than  to  emphasize  its  possibilities  and  symptoms. 
As  in  tuberculosis  of  all  joints,  it  is  incipient  in 
its  onset  and  usually  preceded  by  a history  of 
trauma.  The  physical  examination  is  relatively 
negative  except  for  very  mild,  if  any,  swellinq, 
and  the  patient  complains  of  mild  pain  on  pres- 
sure directly  over  the  flexed  knee  joint  surface. 
The  child  walks  with  a limp.  In  the  early  case  the 


March,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


169 


X-ray  is  negative.  Treatment  should  consist  of 
immobilization  in  a plaster  cast  with  supportative 
constitutional  treatment  as  in  tuberculosis  else- 
where. 

In  the  adult  tuberculous  process,  everything  be- 
ing equal,  it  is  generally  conceded  that  tubercu- 
losis of  the  knee  joint  warrants  only  one  thing, 
resection.  A good  result  rarely  follows  conserva- 
tive treatment  and  so  much  time  is  consumed, 
that  with  the  facts  squarely  before  the  patients, 
most  of  them  will  select  resection  as  the  choice 
of  treatment.  It  must  be  borne  in  mind  that 
tuberculosis  of  the  knee  joint  is  a blood  borne 
disease,  always  secondary  to  a focus  elsewhere 
in  the  body,  therefore,  your  patient  must  be  thor- 
oughly examined  and  searched  for  other  tuber- 
cular foci.  Bear  in  mind  always  that  in  either 
childhood  or  adult  tuberculosis,  the  onset  of  the 
disease  is  gradual  and  the  outstanding  objective 
symptoms  are  a limp,  local  heat,  and  possibly 
flexion  of  the  knee,  while  the  subjective  symp- 
toms are  stiffness  and  pain  on  motion.  Further- 
more, it  is  characterized  by  its  chronicity,  ten- 
dency to  remissions  and  the  fact  that  the  patient 
is  never  completely  free  of  symptoms.  Early 
diagnosis  is  paramount  and  essential.  If  the  diag- 
nosis is  delayed  until  the  lesion  is  so  self-evident 
that  abscess  and  perhaps  sinuses  have  formed 
with  the  customary  secondary  pyogenic  infection, 
the  danger  of  resection  is  greatly  increased.  Two 
cases  that  I wish  to  present  today  are  both 
adults,  one  of  eight  years  standing  and  the  other 
ten  years  standing  prior  to  the  resection.  Both 
patients  now  have  firm,  stable  knees,  and  both 
are  following  the  same  occupation  as  prior  to  the 
onset  of  the  disease. 

Acute  or  chronic  arthritis  may  resemble  in- 
ternal derangements  with  pain  or  tenderness  gen- 
eralized in  a way.  Direct  locking  of  the  joint  is 
seldom  present,  but  there  is  a frequent  complaint 
of  a giving-away  or  a weakness  of  the  joint.  The 
X-ray  is  a big  help  here  and  furnishes  further 
proof  of  the  usual  articular  change. 

Rupture  of  the  crucial  ligaments  and  fractures 
of  the  tibial  spine  are  not  an  uncommon  occur- 
rence and  are  usually  due  to,  or  associated  with, 
direct  violence.  Fracture  of  the  tibial  spine 
presents  a bony  block  on  full  extension  and  is 
easily  noted  on  X-ray  examination.  The  usual 
signs  of  cartilage  derangements  are  absent. 

The  treatment  of  simple  synovitis,  either  acute 
or  chronic,  should  be  very  scientific  and  with 
definite  purposes  in  view.  The  treatment  of  trau- 


matic synovitis  of  the  knee  with  effusion  calls  for 
early  aspiration  followed  by  early  motion  and 
active  use.  This,  as  you  probably  know,  is  in 
marked  contrast  to  the  former  time-honored  te- 
dious immobilization  followed  by  massage,  bak- 
ing and  active  motion.  Early  aspiration  of  the 
acute  effused  knee  makes  possible  almost  imme- 
diate resumption  of  walking  and  a perfect  knee 
in  contrast  to  a disabled  and  weakened  one. 
Furthermore,  we  have  found  in  the  majority  of 
our  aspirations  that  the  fluid  aspirated  is  a bloody 
one  and  not  the  clear  type  so  often  mentioned. 
This  is  due  to  rupture  of  some  intricate  part  of 
the  knee  joint  and  knowing  this,  a clearer  under- 
standing may  be  obtained  of  the  cases  that  be- 
come chronic. 

Following  aspiration,  immediate  actual  weight- 
bearing is  not  recommended.  It  encourages  and 


FIG.  2 

Amount  of  flexion  following  a reconstruction  operation 
for  a congenital  abnormality  of  the  knee. 

further  traumatises  the  injured  parts  and  delays 
rather  than  accelerates  cure.  It  should  be  avoid- 
ed for  about  a week,  meanwhile  permitting  move- 
ment of  the  joint  in  bed  and  while  the  patient 
is  up  on  crutches.  I do  not  hesitate  to  aspirate 
several  times.  In  many  cases,  I open  the  joint, 
wash  it  out  first  with  hot  normal  salt  solution, 
and  follow  with  a weak  iodine  and  glycerine  solu- 
tion. This  same  type  of  treatment  is  also  ap- 
plicable to  any  of  the  milder  types  of  simple  in- 
fectious synovitis  as  well  as  to  the  chronic.  On 
the  other  hand,  many  of  these  cases  progress  to 
a stage  where  hypertrophic  and  atrophic  changes 
have  taken  place.  Then  it  becomes  necessary  to 
resort  to  a more  radical  procedure,  namely,  syn- 
ovectomies. To  emphasize  these  cases,  I am  pre- 


170 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  10 


senting  three  case  histories  and  the  patients  in 
person  showing  the  result  of  synovectomies.  We 
should  select  cases  for  this  type  of  surgery  from 
the  pathological  occurrence  in  the  various  forms 
of  arthritis,  or  after  considering  more  or  less  the 
types  of  classical  arthritis.  Most  of  them  can  be 
said  to  be  suitable  for  synovectomies.  Every 
case  must  be  considered  a problem  to  itself  and 
all  factors  must  be  carefully  considered.  All 
authorities  have  agreed  that  every  possible  focus 
of  infection  should  be  removed  and  conserva- 
tive measures  thoroughly  tried.  When  faced 
with  a chronic  disease  of  the  joint  that  fails  to 
respond  to  conservative  measures,  however,  I 
think  one  is  justified  in  resorting  to  synovectomy. 
All  of  these  cases  have  responded  most  beauti- 


FI0.  3 

Amount  of  extension  gained,  same  as  figure  2. 


fully  to  the  treatment  and  are  here  for  your  in- 
spection. 

DIFFERENTIAL  DIAGNOSIS 
Some  of  the  conditions  that  one  must  con- 
sider before  a final  diagnosis  is  made  are  liga- 
mentous ruptures,  fractures  of  the  tibial  spine, 
periarticular  exostosis,  other  types  of  loose 
bodies,  chronic  arthritis  in  all  forms,  and  a very 
common  condition  which  the  essayist  has  found 
in  a large  percentage  of  knee  conditions,  name- 
ly hypertrophy  of  the  infra-patellar  fat-pad.  Here 
again  the  actual  physical  findings  are  the  key  to 
your  diagnosis,  in  that  the  fat-pad  can  be  seen 
enlarged  on  either  side  of  the  patella.  Full  ex- 
tension may  be  painful,  and  in  most  cases  im- 
possible. True  locking  in  this  condition  is  rare, 
but  the  patient  complains  of  pain  and  recurrent 
effusion  after  even  mild  exercise. 


TREATMENT 

Murphy  has  said,  "An  operation  upon  the  knee 
joint  is  one  of  the  most  difficult  of  all  opera- 
tions." The  indications  for  treatment  of  any 
knee  joint  condition  depend  upon  the  age  of  the 
patient,  the  type  of  lesion  as  besf  determined, 
the  question  of  recurrence,  and  the  severity  of 
associated  symptoms.  Displacements  with  lock- 
ing of  the  knees  occur  occasionally  in  young  chil- 
dren with  moderate  knock-knee  deformity  and 
relaxed  knee  joints.  They  are  usually  bilateral, 
not  associated  with  reactions  or  swelling,  pain  or 
tenderness  and  a period  of  disability.  They  usual- 
ly respond  to  measures  for  correction  of  the 
knock-knee  deformity  and  for  improvement  of 
the  musculature  of  the  legs  and  thighs.  Manipu- 
lation or  operation  is,  therefore,  rarely,  if  ever, 
indicated  in  pre-adolescent  years.  Injuries  of 
the  semilunar  cartilages  are  occasionally  seen 
in  elderly  people.  Such  patients  are  not  good 
operative  risks;  associated  chronic  arthritis  is 
likely  to  make  the  convalescence  prolonged  and 
difficult.  Unless  the  patient  is  unusually  active 
and  well,  non-operative  measures  should  be  em- 
ployed. 

In  case  of  the  initial  injury,  reduction  of  the 
displaced  cartilage  should  be  accomplished  as 
soon  as  possible  and  the  patient  should  be  put 
at  rest  with  the  knee  splintered  until  the  swelling 
has  subsided.  The  subsequent  treatment  may 
then  be  followed.  It  is  essential  in  these  cases, 
however,  to  warn  the  patient  of  the  possibility 
of  recurrences  and  the  importance  of  avoiding 
certain  movements  and  positions  which  are  like- 
ly to  cause  them.  It  is  equally  important  to  plan 
exercises  for  the  development  of  the  thigh  and 
leg  muscles.  The  best  guarantee  against  re- 
currence is  a strong  thigh  musculature,  for  the 
stability  of  the  knee  joint  is  dependent  more 
upon  its  muscular  support  than  upon  its  ligamen- 
tous support.  It  should  be  borne  in  mind  that 
patients  with  any  degree  of  knock-knee  deform- 
ity are  more  subject  to  recurrence  than  those 
with  straight  or  slight  bow-legs.  Overweight 
associated  with  knock-knee  deformity  almost 
guarantees  a recurrence. 

The  treatment  of  acute  cases  consists  in  prop- 
er reduction  of  the  cartilage  whereby  the  knee 
can  be  fully  extended.  If  there  is  present  a 
large  amount  of  effusion,  aspiration  of  the  joint 
should  be  done.  The  knee  then  should  be  placed 
in  a well-fitted  plaster  of  paris  cast  for  com- 
plete immobilization.  In  the  chronic  or  recur- 
rent cases,  or  in  those  in  which  the  cartilage  has 


March,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


171 


been  badly  crushed  or  split,  open  operation  and 
complete  removal  is  indicated,  and  should  be 
done  to  insure  complete  recovery  and  return 
to  a normal  condition. 

The  basis  for  this  article  is  founded  upon  a re- 
view of  198  cases  taken  from  the  files  of  the  es- 
sayist covering  the  period  from  April  1921  to 
April  1934,  and  are  as  follows: 


Arthritis — Acute  Infectious,  non-specific 13 

Chronic  I 6 

Hypertrophic  13 

Suppurative  9 

Displaced  semilunar  cartilages,  internal 26 

Displaced  semilunar  cartilages,  external 3 

Hypertrophy  of  infra-patella  fat-pad ...  16 

Synovitis — Acute  infectious  52 

Chronic  14 

Traumatic,  non-infectious  36 

Total  198 


The  question  of  reconstruction  operations  on 


FIG.  4 


Amount  of  extension  gained  on  left  knee  by  double 
synovectomy.  Amount  of  flexion  gained  on  right  knee 
by  double  synovectomy. 

the  knee,  better  known  as  arthroplasties,  has 
reached  a stable  point  in  recent  years.  There 
is  no  longer-  a doubt  as  to  the  feasibility  of  re- 
construction operations  on  joints  in  general,  es- 
pecially the  knee  joint. 

The  essayist  has  performed  fourteen  opera- 
tions for  reconstruction  of  the  knee  joint.  One 
of  them,  a clinical  case  which  I am  presenting 
today,  is  the  result  of  a congenital  anomaly  of 
the  knee  in  a young  woman  26  years  of  age.  This 
patient  could  flex  the  knee  forward  but  was  un- 
able to  flex  the  knee  backward  in  the  normal 
manner  due  to  the  congenital  maldevelopment  of 


the  condyles  of  the  knee.  This  knee  was  re- 
constructed by  the  writer  some  seven  years  ago 
and  the  patient  is  here  for  your  inspection  to- 
day. 

Again  referring  to  arthroplasties:  they  are  as 
a rule  contraindicated  in  a tubercular  process 
because  of  a likelihood  of  a flare-up  in  an  old 
healed  process.  On  the  whole,  arthroplasties  of 
the  knee  give  satisfactory  results  in  the  majority 
of  cases,  provided  they  are  selected  with  care. 
Much  of  the  success  depends  upon  the  fortitude 
and  courage  of  the  patient  to  carry  through  the 
somewhat  painful  postoperative  physiotherapy. 
Only  then  can  good  results  be  expected. 

CONCLUSIONS 

(1)  Be  sure  of  your  diagnosis  in  knee  joint 
conditions. 

(2)  Proper  surgical  procedure  is  as  scientifical- 
ly indicated  in  the  knee  as  in  any  other  structure 
of  the  human  body. 

(3)  The  presence  of  excess  fluid  in  the  joint 
should  always  be  viewed  with  suspicion. 

(4)  Give  careful  and  repeated  examinations 
in  making  diagnosis  of  internal  derangements  of 
the  knee. 

(5)  Removal  of  the  offending  object  is  the  sure 
way  to  obtain  a cure. 

(6)  Remember  that  operation  upon  the  knee 
joint  is  one  of  the  most  difficult  of  all  operations. 

539  Donaghey  Building,  Little  Rock. 

ANNOUNCEMENT 

Inasmuch  as  the  scientific  exhibits  in  the  past 
at  our  state  meetings  have  constituted  such  a 
large  percentage  of  the  educational  feature  of 
such  assemblies,  the  committee  on  scientific  ex- 
hibits at  this  time  wishes  to  ask  for  a wide  par- 
ticipation in  this  field  by  the  members  of  our 
society.  Doctors  planning  on  having  exhibits  at 
Fort  Smith  on  April  15,  16,  and  17,  are  urged 
to  get  in  touch  with  members  of  this  committee 
as  soon  as  possible  so  that  adequate  space  and 
lighting  facilities  may  be  arranged  for. 

FRED  KROCK,  M.  D„  Chairman, 
Committee  on  Scientific  Exhibits. 

<$> 

COMING  MEDICAL  MEETINGS 

American  College  of  Surgeons,  (District),  Kan- 
sas City,  March  12-1  3th. 

Dallas  Southern  Clinical  Society,  Dallas,  March 
I 8th-22nd. 

Arkansas  Medical  Society,  Fort  Smith,  April 
I 5- 1 7th. 


172 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  10 


THE  EFFECT  OF  POSTURAL  CHANGES 
ON  BLOOD  PRESSURE  AND 
PULSE  RATE* 

CHAS.  H.  LUTTERLOH,  M.  D„  F.  A.  C.  P., 
f Hot  Springs  National  Park. 


Three  cases  presenting  like  symptoms  and 
termed  "postural  hypotension"  were  reported  by 
Bradbury  and  Eggleston1  in  1925.  These  cases 
exhibited  the  following  phenomena:  (I)  a critical 
fall  of  blood  pressure  with  changes  from  the 
horizontal  to  the  upright  position  attended  at 
times  with  syncope,  (2)  a slow  pulse  in  spite  of 
the  marked  fall  in  blood  pressure,  (3)  anhidrosis, 
(4)  an  increased  distress  during  the  heat  of  the 
summer  months  due  to  the  inability  to  perspire 
normally,  (5)  a slight  decrease  in  the  basal  meta- 
bolic rate,  (6)  signs  of  slight  and  indefinite 
changes  in  the  nervous  system,  and  (7)  blood  urea 
at  the  upper  limits  of  normal.  Other  signs  and 
symptoms  often  noted  in  this  condition  were:  (I) 
a greater  excretion  of  urine  during  the  night 
than  during  the  day,  (2)  loss  of  sexual  desire  and 
potency,  (3)  a false  general  appearance  of  youth 
in  comparison  to  the  true  age,  (4)  pallor  of  the 
skin  and  mucous  membranes,  (5)  secondary  anae- 
mia and  (6)  chronic  diarrhea. 

In  a review  of  the  literature  Barker2  has  found 
that  fourteen  cases  of  true  postural  hypotension 
have  been  reported,  including  his  own  case. 
Since  this  review  Sanders3  has  reported  one  ad- 
ditional case  accompanied  by  tachycardia;  Dug- 
gan and  Barr4  have  reported  a case  in  conjunc- 
tion with  Addison's  disease;  and  Allen  and  Ma- 
gee5 have  recently  reported  a case  making  in 
all  a total  of  17  cases.  All  of  the  reported  cases 
manifested  some  of  the  above  mentioned  phe- 
nomena. The  drop  in  the  systolic  pressure  from 
the  horizontal  to  the  upright  position  was  usual- 
ly marked,  being  as  a rule  50  points  or  more  with 
a corresponding  drop  in  the  diastolic  pressure. 
This  sudden  drop  was  usually  associated  with 
symptoms  of  marked  dizziness,  a definite  pallor, 
and  in  most  instances,  syncope.  In  several  of 
these  cases  the  pulse  did  not  remain  slow  and 
constant  but  on  change  of  position  a marked  in- 
crease in  the  pulse  rate  was  noted  as  in  the  last 
case  reported  by  Sanders3. 

The  etiology  of  this  condition  is  not  known  but 
according  to  Ghrist6,  "the  physiologic  abnormal- 
ity probably  consists  in  a hypofunction  of  certain 
parts  of  the  sympathetic  nervous  system,  or  in 

* Submitted  for  publication  December  27,  1934. 


other  words,  a defective  vasomotor  tone.  This 
defective  vasomotor  tone  may  arise  from  either 
(I)  a paralysis,  inhibition  or  dysfunction  in  the 
nervous  mechanism  of  vasomotor  control  which 
in  turn  is  influenced  by  the  circulatory  hormones 
of  glandular  secretion;  (2)  an  atony  or  a paralysis 
of  the  myoneural  juncture  in  the  peripheral,  es- 
pecially the  splanchnic  vessels;  or  (3)  changes  in 
the  character  of  the  vessels  themselves." 

The  treatment  of  this  condition  has  been  prin- 
cipally the  administration  of  ephedrine  sulphate. 
Ghrist  and  Brown7  have  reported  beneficial  re- 
sults in  one  of  their  cases,  and  the  case  reported 
by  Barker2  showed  improvement  on  this  form  of 
medication;  however,  in  the  majority  of  cases  no 
form  of  treatment  has  been  successful.  In  the 
case  reported  by  Barker2  where  anhidrosis  was 
one  of  the  cardinal  symptoms,  the  oral  adminis- 
tration of  pilocarpine  hydrochloride  during  the 
summer  months  seemed  to  make  the  patient 
more  comfortable. 

My  interest  in  postural  hypotension  was  arous- 
ed through  the  study  of  a case,  the  report  of 
which  follows,  in  which  the  patient  presented 
several  of  the  characteristic  symptoms  of  this 
disease. 

W.  M.,  male,  age  52,  a physician,  presented  the  fol- 
lowing symptoms:  a feeling  of  fatigue  with  marked  dizzi- 
ness and  faintness  while  in  the  upright  position,  which 
was  relieved  to  some  extent  by  a sitting  or  recumbent 
position,  difficulty  in  staying  awake,  swelling  of  the  feet 
and  ankles,  nocturia  and  a diminished  sexual  power  and 
tendency  to  impotence.  These  symptoms  had  been  pres- 
ent for  a period  of  over  a year  and  of  late  had  become 
more  marked.  The  family  history  was  irrelevant  except 
that  the  mother  had  died  of  a branchiogenic  carcinoma. 
The  past  history  was  negative  except  for  scarlet  fever 
during  childhood.  The  veneral  history  was  negative. 

Physical  examination  revealed  a well  developed,  well 
nourished  male  who  had  the  appearance  of  a person  not 
over  his  stated  age  of  52.  The  head  and  neck  were  es- 
sentially negative  except  that  the  conjunctiva  and  mucous 
membranes  were  paler  than  normal.  The  heart  was  some- 
what rapid  but  regular,  the  pulse  was  90  and  of  fair 
volume.  The  heart  sounds  were  distinct  and  no  murmurs 
were  elicited.  The  blood  pressure  with  patient  in  the 
sitting  position  was  100/70.  The  lungs  were  negative. 
Examination  of  the  abdomen  revealed  no  abnormalities. 
The  external  genitalia  and  prostate  were  negative.  The 
extremities  were  normal  except  for  a slight  edema  of  the 
ankles.  The  skin  was  smooth,  moist  and  presented  a yel- 
lowish tinge,  however  there  were  no  areas  of  pigmenta- 
tion noted.  Neurological  examination  was  negative  ex- 
cept that  the  gait  and  station  were  somewhat  unsteady 
which  I attributed  to  weakness. 

Laboratory  findings:  The  urine  was  negative  except  for 
a trace  of  albumin  and  a few  hyaline  casts.  The  intra- 
venous P.  S.  P.  test  showed  70%  the  first  hour,  20%  the 
second  hour.  The  Kohlmer  Wasserman  was  negative,  the 


March,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


173 


Kahn  was  negative.  The  blood  count  was:  hemoglobin 
(Sahli)  80%;  red  blood  cells  4,300,000;  white  blood  cells 
6,100;  neutrophiles  46%;  small  lymphocytes  50%;  eosino- 
philes  4%.  No  malaria  parasites  were  noted.  Blood 
chemistry  revealed:  Sugar,  140  mg.  per  hundred  cubic 
centimeters,  repeated  a few  days  later  110  mg.;  urea 
nitrogen  17  mg.;  creatinin  I mg.  Basal  metabolic  rate 
was  0.  Examination  of  the  prostatic  secretion  was  nega- 
tive. Examination  of  the  feces  was  also  negative. 

The  symptoms  presented  by  this  patient  defi- 
nitely suggested  the  possibility  of  postural  hypo- 
tension hence  the  following  observations  of  blood 
pressure  and  pulse  rate  were  made  in  the  re- 
cumbent, sitting  and  standing  positions  on  vari- 
ous days  and  at  different  times  of  the  day  dur- 
ing a period  of  two  weeks.  Two  full  minutes  were 
allowed  between  each  change  of  position.  The 
results  are  shown  in  the  following  table. 


OBSERVATIONS  ON  BLOOD  PRESSURE  AND 
PULSE  RATE 


BLOOD 

PRESSURE 

PULSE  RATE 

Recumbent 

Sitting 

Standi 

mg 

Recum- 

bent 

' C7> 

C 

CO  ~ 

Stand- 

ing 

Sys. 

Dias, 

. Sys. 

Dias. 

Sys. 

Dias. 

130 

84 

1 14 

84 

1 14 

84 

76 

88 

96 

124 

82 

1 10 

80 

1 10 

78 

68 

90 

92 

1 12 

66 

90 

60 

88 

60 

74 

90 

94 

1 10 

66 

92 

62 

90 

58 

72 

92 

96 

i 16 

70 

100 

68 

100 

66 

74 

88 

90 

These  findings  revealed  a rather  unstable  pres- 
sure, there  being  a drop  in  the  systolic  pressure 
ranging  from  14  to  24  points  and  a drop  in  the 
diastolic  pressure  from  0 to  8 points  from  the 
recumbent  to  the  standing  position.  It  was  also 
noted  that  there  was  a corresponding  rise  in 
pulse  rate  ranging  from  14  to  24  points  coinci- 
dent with  the  fall  in  blood  pressure. 

This  case  probably  was  not  a true  case  of  pos- 
tural hypotension  due  to  the  fact  that  the  vari- 
ance in  blood  pressure  on  postural  change  was 
not  marked  enough  nor  did  it  fall  to  a sufficient- 
ly low  level  at  any  time  to  produce  attacks  of 
syncope.  I believe,  however,  it  could  be  con- 
sidered a border  line  case  and  the  symptoms 
which  the  patient  presented  were  due  to  a vaso- 
motor imbalance.  This  patient  showed  some 
improvement  and  was  made  much  more  comfort- 
able by  taking  ephedrine  sulphate  three-eighths 
grain  (0.024  gm.)  three  or  four  times  daily. 

From  the  observations  made  in  the  manage- 
ment of  this  case,  I decided  to  note  changes  in 
blood  pressure  and  pulse  rate  as  affected  by  va- 
rious interrupted  changes  in  posture,  starting  at 
a position  lower  than  horizontal  and  ending  with 
a vertical  position,  on  a group  of  50  normal  in- 
dividuals. Studies  of  the  normal  circulatory  re- 


sponse to  changes  of  posture  by  various  meth- 
ods have  been  reported  by  Hill8,  Kernohan9, 
Mortensen10,  Schneider11  and  Ghrist6. 

The  above  mentioned  group  comprised  25 
men  and  25  women,  the  ages  ranging  from  18 
to  64  years,  the  average  age  being  30  plus.  The 
observations  were  made  at  the  same  time  each 
day,  between  3 and  4 P.  M.  The  blood  pres- 
sure cuff  was  applied  to  the  right  arm  in  each 
case,  the  same  instrument  of  a mercury  type  be- 
ing used  for  all  observations.  The  blood  pres- 
sure apparatus  was  kept  on  an  approximate  level 
with  the  patient's  heart  during  all  observations. 
The  work  was  done  on  a motor  driven  X-ray 
table,  the  approximate  angles  being  225  degrees, 
180  degrees  and  90  degrees.  The  technique  of 
the  procedure  was  explained  in  detail  to  each  in- 
dividual so  as  to  avoid  the  psychic  element  as 
much  as  possible.  Two  full  minutes  were  allowed 
between  each  change  of  position  for  stabiliza- 
tion of  the  circulatory  apparatus.  The  accom- 
panying diagram  shows  the  results  obtained. 


My  results  showed  that  the  normal  responses 
to  interrupted  changes  in  posture  from  below 
horizontal  to  the  upright  position  were  a slight 
fall  in  the  systolic  pressure,  a definite  rise  in  the 
diastolic  pressure  and  a definite  rise  in  the 
pulse  rate.  An  explanation  for  the  rise  in  pulse 
rate  and  rise  in  diastolic  pressure  may  be  stated 
as  follows:  in  order  to  overcome  the  hydrostatic 
effect  of  gravity  in  the  upright  position,  the  car- 
diac rate  is  increased,  also  in  like  manner  a vaso- 
pressor response  takes  place  in  the  peripheral 
circulation,  which  produces  a sufficient  rise  in  the 


174 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  10 


diastolic  blood  pressure  to  preclude  the  possibil- 
ity of  cerebral  anaemia. 

SUMMARY 

1.  At  the  present  time  17  cases  of  a definite 
disease  entity  termed  "postural  hypotension" 
have  been  reported  in  the  literature.  All  of 
these  cases  presented  some  of  the  cardinal  phe- 
nomena of  the  disease  and  all  showed  a wide  va- 
riance in  blood  pressure  on  change  from  recum- 
bency to  the  upright  position.  This  marked 
change  in  blood  pressure  was  usually  accompa- 
nied by  attacks  of  syncope. 

2.  The  case  reported  in  this  paper  was  not  one 
of  true  postural  hypotension,  because  the  vari- 
ance in  blood  pressure  on  postural  change  was 
not  marked  enough  and  at  no  time  did  the  pres- 
sure fall  sufficiently  low  to  produce  syncope.  The 
case  could  be  considered  a border  line  case, 
however,  and  the  symptoms  presented  were 
probably  due  to  a vasomotor  imbalance.  This 
case  responded  nicely  to  ephedrine  sulphate. 

3.  The  effect  of  interrupted  changes  in  pos- 
ture from  a position  below  horizontal  to  the  up- 
right position  was  noted  on  a series  of  fifty  nor- 
mal individuals  with  the  following  results:  a slight 
fall  in  the  systolic  pressure,  a definite  rise  in  the 
diastolic  pressure  and  a definite  rise  in  the  pulse 
rate. 

BIBLIOGRAPHY 

1.  Bradbury,  S.,  and  Eggleston,  C.:  Postural  Hpyoten- 
sion,  Am.  Heart.  J.,  1925,  I,  73,  and  1927,  3,  105. 

2.  Barker,  N.  W.:  Postural  Hypotension:  Report  of  a 
Case  and  Review  of  the  Literature.  Med.  Clin.  N.  Amer., 
1933,  16,  1301-1312. 

3.  Sanders,  A.  O.:  Postural  Hypotension  with  Tachy- 
cardia. A Case  Report.  Am.  Heart  J.,  1932,  7,  808. 

4.  Duggan,  LeR.  B.,  and  Barr,  D.  P.:  Postural  Hypoten- 
sion Occurring  in  a Negro  with  Addison's  Disease.  En- 
docrinology, 1931,  15,  531-535. 

5.  Allen,  Edgar  V.,  and  Magee,  H.  Ross:  Orthostatic 
(Postural)  Hypotension  with  Syncope.  Med.  Clin.  N. 
Amer.,  1934,  18,  585-595. 

6.  Ghrist,  D.  G.:  Variations  in  Pulse  and  Blood  Pres- 
sure with  Interrupted  Change  of  Posture.  Ann.  Int.  Med., 
1931,  4,  945-958. 

7.  Ghrist,  D.  G.,  and  Brown,  G.  E.:  Postural  Hypoten- 
sion with  Syncope;  its  Successful  Treatment  with  Ephe- 
drine. Am.  Jour.  Med.  Soc.,  1928,  175,  336-394. 

8.  Hill,  Leonard  and  Barnard,  Harold:  The  Influence 
of  the  Force  of  Gravity  on  the  Circulation.  Part  II.  Jour. 
Physiol.,  1897,  21,  323-352. 

9.  Kernohan,  J.  W.,  Anderson,  E.  W.,  and  Keith,  N. 
M.:  The  Arterioles  in  Cases  of  Hypertension.  Arch.  Int. 
Med.,  1929,  44,  395-423. 


10.  Mortensen,  M.  A.:  Blood-pressure  reactions  to  Pas- 
sive Postural  Changes:  An  Index  to  Myocardial  Efficiency. 
Am.  Jour.  Med.  Soc.,  1923,  165,  667-675. 

11.  Schneider,  E.  C.  and  Truesdell,  D.:  A Statistical 
Study  of  Pulse  Rate  and  the  Arterial  Blood  Pressures  in 
Recumbency,  Standing,  and  after  a Standard  Exercise. 
Am.  Jour.  Physiol.,  1922,  61,  429-474. 

<J> 

CORRESPONDENCE 


The  Editor  of  The  Journal, 

Arkansas  Medical  Society, 

Fort  S mi  th,  Ark. 

Dear  Sir: 

The  following  case  was  new  to  me  and  none  of  the 
doctors  with  whom  I have  discussed  it  has  known  what 
was  meant  by  water-trap  stomach  until  it  was  explained 
to  them. 

The  patient  was  about  four  months  old  and  had  been 
seen  previously  by  two  doctors.  There  was  a history  of 
a cold,  upset  bowels,  and  vomiting.  The  usual  treat- 
ment cleared  up  all  but  the  vomiting.  "The  baby  vomits 
every  thing,  even  mother's  milk,"  said  the  mother.  Pro- 
jectile vomiting  was  not  present  according  to  the  family. 

Suspecting  pyloric  stenosis,  however,  an  X-ray  exami- 
nation v/as  advised.  I quote  from  that  report: 

'The  examination  of  the  stomach  showed  no  obstruc- 
tion and  showed  peristalsis  to  be  normal.  The  stomach 
is  of  fhe  water-trap  type  with  the  cardia  and  fundus  lying 
up  under  the  left  arch  of  the  diaphram.  When  the  baby 
lies  on  its  back  or  left  side,  the  gastric  contents  fail  to 
reach  the  antrum  and  pyloric  ring.  This  is  the  only  type 
of  obstruction  noted  and  it  disappears  when  the  baby  is 
placed  on  the  right  side  or  on  its  abdomen.  The  duod- 
eum  appears  to  be  normal." 

The  bowl  of  our  commodes  offers  the  best  known  ex- 
ample of  what  a water-trap  is. 

Keeping  this  baby  off  of  its  back  and  left  side  by 
proping  it  up  after  feeding  has  been  the  only  treatment 
since  the  diagnosis  was  made.  This  has  been  satisfac- 
tory as  a report  made  a few  days  ago  revealed  thaf  there 
had  been  no  further  vomiting. 

Yours  truly, 

HOMER  SCOTT,  M.  D. 

<$> 

ANNOUNCEMENT 


There  will  be  a meeting  of  a section  of  the 
American  College  of  Surgeons,  embracing  the 
states  of  Missouri,  Kansas,  Arkansas,  Iowa,  Ne- 
braska, Oklahoma,  and  Colorado  at  Kansas  City, 
Missouri,  on  March  12th  and  13th. 

The  Kansas  City  surgeons  are  preparing  for  a 
large  meeting.  There  will  be  entertainment  and 
clinics  for  members  and  non-members  as  well. 
Arkansas  surgeons  will  be  well  rewarded  for  at- 
tending. 

H.  MOULTON,  M.  D„  Counselor 
for  State  Executive  Com- 
mittee of  Arkansas. 


March,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


175 


SPECIAL  ARTICLE 


SICKNESS  INSURANCE  CATECHISM* 


[.  What  Is  Sickness  Insurance? 

Sickness  insurance  is  proposed  as  a method  of 
distributing  the  economic  burden  of  sickness.  The 
first  purpose  was  to  distribute  the  burden  of 
unemployment  due  to  sickness.  This  is  still  the 
controlling  motive  in  most  of  the  systems  and 
absorbs  the  larger  part  of  their  resources  and 
determines  their  organization  and  administra- 
tion. Medical  service  in  the  beginning  was  looked 
on  primarily  as  a means  of  reducing  the  burden 
of  cash  payments  during  sickness.  This  pattern 
still  dominates,  although  the  medical  service  is 
now  urged  as  the  principal  objective.  The  ad- 
ministrative machinery  is  still  designed  to  collect, 
manage  and  distribute  cash.  It  is  in  no  way 
suited  to  administer  a medical  service. 

2.  How  Does  Insurance  Affect  the  Medical 

Service? 

Medical  service,  unlike  cash  or  material  com- 
modities, cannot  be  collected,  stored  and  dis- 
tributed without  changing  its  qualities.  Its  value 
depends  on  the  relations  between  the  producer 
(the  physician)  and  the  consumer  (the  patient). 
Its  distribution  is  a part  of  the  service.  The  in- 
troduction of  a third  party  who  is  neither  physi- 
cian nor  patient  is  equivalent  to  adulteration  of 
the  service. 

3.  How  Does  Sicknes  Insurance  Affect  Diagnosis? 

Since  insurance  administration  is  controlled  by 
cash  considerations,  quantity,  rather  than  qual- 
ity, of  medical  service  is  stressed.  The  essen- 
tials of  a good  diagnosis  are  time,  patience, 
careful  attention  to  details  and  sympathetic  re- 
lations between  a skilled  practitioner  and  a co- 
operating patient.  Insurance  compels  haste  and 
tends  to  create  antagonism  between  patient  and 
physician.  By  removal  of  the  essentials  men- 
tioned, insurance  delivers  little  more  than  the 
dregs  of  a real  diagnosis.  The  effort  to  substi- 
tute for  these  essentials  something  that  will  fit 
the  cash  standards  of  insurance  causes  exaggerat- 
ed importance  to  be  given  to  mathematical  and 
mechanical  analyses,  pictures,  and  measure- 
ments. But  these  are  only  one  set  of  valuable, 
but  often  isolated,  facts  that  must  be  integrated 
with  the  personal  interview,  history  and  individ- 
ual examination  through  the  knowledge  and  ex- 

*  Prepared  by  the  Bureau  of  Medical  Economics,  Amer- 
ican Medical  Association,  Chicago. 


perience  of  the  physician.  Insurance  tends  to 
restrict  this  most  vital  part  of  the  diagnosis. 

4.  How  Does  Insurance  Affect  Treatment? 

Insurance  almost  inevitably  leads  to  overmedi- 
cation. It  has  become  well-nigh  proverbial  that 
the  diagnosis  and  treatment  provided  in  insur- 
ance systems  consists  of  a "look  and  a bottle." 
Insurance  seeks  to  check  the  steadily  rising  cost 
of  drugs  by  the  application  of  cash  standards 
through  restrictions  on  prescribing.  Since  sick 
individuals  and  scientific  medical  service  do  not 
fit  these  standards,  treatment  is  hampered  while 
the  evil  of  unnecessary  medication  remains. 

5.  Do  the  Best  Physicians  Enter  Insurance  Prac- 
tice? 

The  Germans  have  a saying  that  "insurance 
service  is  always  second  class."  While  there  are 
many  individual  exceptions,  few  would  deny  that 
in  countries  which  have  sickness  insurance  the 
median  level  of  ability  is  lower  among  insur- 
ance than  private  practitioners.  Although  the 
British  Medical  Association  favors  insurance,  and 
the  conditions  of  practice  are  less  unsatisfac- 
tory than  in  almost  all  other  systems,  only  about 
half  of  the  licensed  practitioners  have  expressed 
a willingness  to  enroll  under  the  insurance  regu- 
lations. 

6.  Does  Insurance  Decrease  the  Amount  of  Sick- 
ness Among  the  Insured? 

Few  achievements  of  the  modern  scientific  age 
are  more  striking  than  the  conquest  of  once 
widespread  diseases  in  the  progress  of  medical 
discovery.  A host  of  diseases  like  smallpox,  yel- 
low fever,  malaria  and  typhoid  fever,  which  were 
once  among  the  largest  causes  of  sickness  and 
death,  have  been  abolished  or  reduced  to  a- frac- 
tion of  their  former  importance.  In  many  others, 
improved  methods  of  treatment  have  shortened 
the  period  of  recovery.  While  morbidity  statis- 
tics are  inadequate  in  the  United  States,  such 
evidence  as  is  available  indicates  a decline  in  the 
amount  of  serious  sickness  from  a number  of  cas- 
es. Although  most  of  the  advances  in  medicine, 
together  with  the  improvements  in  sanitation  and 
public  health  measures  that  are  characteristic  of 
modern  civilization,  are  found  in  countries  having 
sickness  insurance,  yet  among  the  insured  under 
practically  every  system  the  records  show  a con- 
stant increase  of  morbidity.  This  increase  is  not 
entirely  due  to  the  demand  for  "certificates  of 
incapacity  to  work,"  required  to  secure  cash 
benefits.  This  constitutes  such  a large  and  grow- 
ing evil  that  in  nearly  every  country  having  a 


176 


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[Vol.  XXXI,  No.  10 


sickness  insurance  system  there  is  developing  a 
strong  and  increasing  movement  for  a complete 
separation  of  cash  and  service  benefits.  The 
increase  in  sickness  among  the  insured  is  due  to 
a deep  inherent  evil  in  insurance.  Various  studies 
of  fairly  large  numbers  of  patients  have  led  to 
the  conclusion  that  from  40  to  75  per  cent  of 
all  illnesses  are  complicated  by  mental  disturb- 
ances. Insurance  methods  of  treatment  make 
almost  impossible  the  patience,  time,  careful  in- 
vestigation and  lengthy  care  with  close  personal 
relations  that  such  patients  require.  Moreover, 
as  studies  of  many  systems  have  shown,  insurance 
actually  arouses  conflicts,  anxieties  and  desires 
that  aggravate  existing  illnesses  and  create  a 
host  of  new  ones  which  cannot  be  treated  prop- 
erly by  the  methods  that  prevail  under  insurance. 
Prepayment  for  medical  care,  especially  over  a 
long  period,  creates  a desire  to  "get  something 
back"  in  the  form  of  such  care.  This  desire  to 
"get  something  back"  has  a tendency  to  create 
the  sickness  that  is  the  condition  of  obtaining 
the  coveted  service.  This  is  not  malingering  nor 
even  quite  the  same  as  the  "traumatic,  neuroses" 
that  cause  so  much  trouble  in  workmen's  com- 
pensation practice.  In  the  latter  cases  there  is 
at  least  a real  or  imagined  injury  as  a beginning. 
But  the  cases  under  insurance  are  originated  by 
insurance.  Every  sickness  insurance  system  furn- 
ishes ample  illustrations  of  these  harmful  develop- 
ments. Physicians  practicing  in  the  German  sys- 
tem estimate  that  from  30  to  50  per  cent  of  the 
cases  treated  are  created  or  aggravated  by  this 
situation.  Fifty  years  of  this  system  in  the  period 
of  greatest  medical  progress  in  the  war  on  dis- 
ease has  almost  trebled  recorded  "morbidity" 
among  the  German  insured. 

7.  Does  Insurance  Increase  the  Practice  of  Pre- 
ventive Medicine? 

Even  the  most  enthusiastic  advocates  of  in- 
surance admit  that  sickness  insurance  has  done 
little  to  develop  or  encourage  measures  for  the 
prevention  of  disease.  Individual  immunization, 
regular  health  examinations  and  measures  for 
the  detection  and  treatment  of  incipient  disease 
are,  in  all  insurance  countries,  largely  dependent 
on  other  agencies  than  insurance.  The  Insur- 
ance practitioner  is  too  hurried  and  is  held  too 
closely  by  restrictions  imposed  by  administra- 
tors to  give  much  attention  to  preventive  work. 
Such  preventive  work  is  more  extensive,  reaches 
a larger  percentage  of  the  population  and  is 
better  supported  by  the  general  public  and  the 
medical  profession  in  fhe  United  States  than  in 
countries  having  compulsory  sickness  insurance. 


8.  Does  Sickness  Insurance,  by  Furnishing  Un- 
limited Free  Medical  Service,  Encourage  the 

Detection  and  Treatment  of  Incipient  Disease? 

It  is  highly  probable  that  even  the  superficial 
examinations  encouraged  by  insurance  methods 
detect  some  such  diseases  that  might  not  other- 
wise have  been  brought  to  medical  attention. 
There  are  many  physicians  practicing  under  in- 
surance whose  professional  integrity  and  scien- 
tific ability  enable  them  to  overcome  the  con- 
ditions encouraged  by  insurance  and  to  select 
for  thorough  diagnosis  those  threatened  by  se- 
rious disease.  It  is  somewhat  significant  that 
none  of  the  often  over-enthusiastic  propagandists 
of  insurance  have  ever  collected  any  facts  to 
demonstrate  whether  cancer  or  tuberculosis,  for 
example,  are  more  frequently  detected  at  an 
early  stage  among  the  insured  than  among  the 
noninsured.  On  the  other  hand,  many  physicians 
with  experience  under  insurance  declare  that  the 
flood  of  patients  with  imaginary  or  trivial  com- 
plaints, or  who  come  only  to  prove  they  are  sick 
in  order  to  draw  cash  relief  or  to  "get  some- 
thing back"  from  their  contributions,  that  crowd 
the  office  'of  an  insurance  physician  not  only 
compel  a tendency  toward  hasty  or  superficial 
diagnosis  but  lead  to  suspicion  of  the  actuality 
of  symptoms  described  by  the  patient,  and  a 
disbelief  in  the  existence  of  serious  disease.  The 
whole  economic  organization  of  insurance  en- 
courages attitudes  and  conditions  hostile  to  a 
thorough  detection  of  incipient  disease. 

9.  Does  Sickness  Insurance  Lower  the  Death 

Rate? 

The  progress  of  medical  science  has  been 
marked  in  every  modern  nation  by  a more  rapid 
decline  in  mortality  during  the  last  half  century 
than  in  any  of  the  preceding  centuries.  The 
application  of  the  triumphs  of  surgery,  epidemi- 
ology, immunization  and  the  advances  in  diag- 
nosis and  treatment  in  a multitude  of  directions 
has  added  a score  of  years  to  the  average  life. 
Where  these  advances  in  medical  science  have 
been  utilized  in  public  health  work  and  private 
practice  it  is  possible  to  demonstrate  statistical- 
ly their  effect  in  reducing  the  death  rate.  But 
the  advocates  of  insurance  have  not  been  able 
to  show  a similar  statistical  connection  between 
the  introduction  or  extension  of  insurance  and  a 
decline  in  the  death  rate. 

10.  Does  Sickness  Insurance  Reduce  the  Cost  of 
Medical  Care? 

Before  this  question  can  be  answered  propel1 
ly  it  is  necessary  to  have  some  comparative  stand- 


March,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


177 


ards  of  medical  care.  These  do  not  exist.  II 
is  certain  that  the  first  effect  of  insurance  is  to 
divert  a considerable  share  of  the  contributions 
for  medical  care  to  costs  of  administration.  In 
Germany  (almost  the  only  country  where  such 
statistics  are  available)  there  are  more  sickness 
insurance  administrators  than  physicians  in  the 
scheme.  The  physician  must  spend  a consider- 
able portion  of  his  time  as  a routine  clerical 
worker  filling  out  the  numerous  blanks  and  re- 
ports required.  Not  only  is  this  a wasteful  use 
of  professional  skill  but  it  still  further  reduces 
the  already  scanty  time  available  for  medical 
service  and  prevents  the  continuous  study  essen- 
tial to  good  medical  service.  While  no  com- 
parative statistics  are  available,  and  probably 
would  be  impossible  to  gather,  all  obtainable  in- 
formation seems  to  lead  to  the  conclusion  that, 
considering  all  national  differences,  no  less  sums 
are  spent  for  medical  care  for  the  insured  than 
are  spent  by  the  uninsured,  with  the  same  eco- 
nomic resources. 

11.  How  Are  Physicians  Chosen  for  Insurance 
Practice? 

There  are  wide  differences  in  the  various  sys- 
tems. In  some  there  are  so  many  restrictions 
and  conditions  that  the  physician  is  practically 
selected  by  the  administrators.  Where  this  is 
true  and  insurance  is  compulsory  for  a large  por- 
tion of  the  population,  it  amounts  to  a secondary 
system  of  licensure,  the  conditions  of  which  are 
acceptance  of  rules  and  regulations  often  estab- 
lished for  reasons  other  than  the  furtherance  of 
good  medical  practice.  In  the  French,  English 
and  Scandinavian  systems  any  licensed  physician 
may  enter  insurance  practice  by  simply  agreeing 
to  meet  the  condition  set  up  by  the  law. 

12.  How  Do  the  Indigent  Receive  Medical  Care 
Under  Sickness  Insurance? 

Insurance  leaves  almost  untouched  the  entire 
problem  of  care  for  the  indigent  sick  who  are 
not  eligible  to  the  benefits  of  sickness  insurance 
systems.  In  no  country  has  it  perceptibly  de- 
creased expenditures  for  this  purpose. 

13.  What  Has  Been  the  Effect  of  Insurance  on 
the  Medical  Profession? 

Economically  its  first  effect  in  many  countries 
was  to  increase  somewhat  the  incomes  of  physi- 
cians whose  practice  was  largely  confined  to  the 
low  income  classes.  Many  patients  who  had 
hitherto  paid  nothing  for  medical  care  now  had 
something  paid  for  them  through  insurance. 
Later,  in  most  systems,  the  income  of  physicians 
in  insurance  practice  was  reduced  and  at  the 


same  time  the  field  for  private  practice  had  be- 
come so  contracted  that  the  total  average  of 
income  was  lower.  Almost  any  system  would 
have  improved  the  conditions  of  English  physi- 
cians-where  "medical  clubs"  prevailed.  The 
members  of  these  clubs  paid  a few  cents  week- 
ly or  monthly  for  which  physicians  agreed  to  give 
a sort  of  medical  care.  One  of  the  arguments 
for  insurance  was  that  it  would  abolish  the  abuses 
of  the  "ciubs,"  but  these  are  now  returning  on 
a large  scale  in  spite  of  insurance,  and  bringing 
nearly  all  the  old  abuses  with  them.  In  Eng- 
land, where  only  the  actual  worker  and  not  his 
dependents  are  covered  by  insurance,  the  aver- 
age income  of  panel  physicians  from  insurance 
is  little  over  $2,000  a year,  out  of  which  he  must 
pay  the  expenses  of  his  practice.  These  physi- 
cians still  have  some  private  practice,  but  pro- 
posals now  being  considered  to  extend  that  sys- 
tem will  further  restrict  this  field  of  independent 
private  practice.  The  panel  physician  is  paid 
a little  over  $2  per  person  annually  and  must 
therefore  have  approximately  1 ,000  persons  on 
his  panel  in  order  to  receive  $2,000.  Payment 
for  physicians  under  the  English  system  is  gen- 
erally considered  to  be  better  than  under  any 
other  system.  The  number  of  persons  per  physi- 
cian in  the  United  States  is  a little  over  800. 

14.  What  Is  the  Effect  of  Insurance  on  Gradu- 
ate Study  of  Physicians? 

Medical  progress  is  so  rapid  as  to  require  con- 
stant study  by  the  physician  who  wishes  to  use 
the  most  approved  methods  of  diagnosis  and 
treatment.  Many  state  medical  societies  in  the 
United  States  spend  a considerable  amount  of 
their  time  and  energy  in  furnishing  their  mem- 
bers with  facilities  for  postgraduate  study  and 
in  encouraging  their  members  in  all  forms  of 
professional  improvement.  Administrators  of  in- 
surance systems  also  encourage  a form  of  grad- 
uate study.  They  establish  institutions  to  teach 
how  to  make  out  insurance  reports,  to  detect 
malingering,  to  keep  down  the  cost  of  prescrib- 
ing and  to  meet  the  regulations  provided  by  in- 
surance. The  physician  who  spends  his  time  in 
this  kind  of  study  has  little  additional  time  left 
from  his  overworked  insurance  practice  to  keep 
up  with  scientific  advance. 

15.  Has  It  Been  Possible  to  Apply  a Uniform 
Health  Insurance  System  Throughout  the 
Countries  in  Which  These  Systems  Have 
Been  Adopted? 

In  nearly  every  country,  local  conditions  have 
forced  modifications  of  the  general  plan.  The 


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THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  10 


mountainous  sections  of  Switzerland,  the  High- 
lands and  Islands  of  Scotland,  the  farming  sec- 
tions of  France  and  the  miners  of  Germany  are 
examples  of  conditions  where  the  general  sys- 
tem had  to  be  greatly  modified  or  entirely  dis- 
carded to  meet  local  conditions.  There  are  as 
wide  diversities  in  almost  any  of  the  states  of 
the  United  States  as  are  to  be  found  in  Euro- 
pean countries.  It  is  quite  certain  that  the  best 
possible  general  plan  that  could  be  devised  could 
not  be  adjusted  to  all  the  varying  conditions 
throughout  the  United  States  or  even  in  differ- 
ent sections  within  many  of  the  states. 

16.  Who  Have  Been  the  Advocates  of  Sickness 
Insurance? 

The  most  significant  general  fact  is  that  in  no 
country  have  either  the  physicians  who  are  to 
give  the  service  or  the  proposed  beneficiaries 
of  that  service  ever  asked  for  it.  In  most  coun- 
tries its  introduction  was  opposed  by  both 
groups.  In  a few  countries  in  recent  years,  where 
voluntary  insurance  societies  had  been  organized 
among  laborers  and  found  themselves  in  finan- 
cial difficulties,  these  societies  were  able  to  se- 
cure the  support  of  their  members  and  some- 
times of  the  political  parties  of  labor  for  state 
subsidies  and  then  for  a compulsory  system.  The 
demand  in  these  cases  does  not  appear  to  have 
come  from  the  membership  but  from  the  officials 
of  the  societies  that  were  in  financial  difficulties 
and  from  the  labor  politicians  who  saw  in  the 
societies  an  extensive  political  machine.  The 
first  advocates  of  sickness  insurance  have  almost 
always  been  social  workers  and  philanthropists. 
These  groups  and  individuals  see  in  sickness  in- 
surance a simplification  of  their  work  in  provid- 
ing medical  relief.  Neither  are  they  blind  to  the 
fact  that  the  introduction  of  a system  of  sick- 
ness insurance  will  involve  the  employment  of 
large  numbers  of  such  social  workers. 

17.  Have  Sickness  Insurance  Systems  Become  In- 
volved in  Politics? 

In  every  country  having  such  a system,  the 
administrations  of  insurance  have  developed  into 
powerful  political  machines.  When  benefits  are 
distributed  to  individuals  through  an  extensive 
administrative  machinery  with  many  employees, 
the  whole  scheme  tends  to  become  a gigantic 
political  machine.  This  always  has  evil  effects 
on  the  quality  of  the  medical  service.  Patients 
are  not  able  to  judge  the  quality  of  medical 
service.  They  prefer  free  drugs  to  thorough 
diagnosis,  and  the  politicians  will  give  them  what 
they  want  without  regard  to  the  effect  on  their 


health.  This  has  been  the  tendency  in  nearly 
every  system  of  sickness  insurance. 

18.  What  Is  the  Position  of  the  Organized  Medi- 
cal Profession  on  Sickness  Insurance? 

The  medical  profession  has  always  maintained 
that  its  mission  is  to  fight  disease  and  guard  the 
health  of  the  people.  It  is  to  medicine  and  the 
scientific  achievements  encouraged  by  it  that 
the  world  owes  its  amazing  progress  in  the  bat- 
tle against  disease.  Organized  medicine  in  the 
United  States  has  been  responsible  for  the  origin 
of  public  health  departments  and  the  constantly 
rising  standards  of  medical  education,  licensure 
and  hospital  practice.  While  every  other  occu- 
pation avows  its  mission  to  be  the  improvement 
of  the  economic  conditions  of  its  members,  the 
medical  profession  has  always  insisted  that  its 
main  mission  is  to  protect  the  welfare  of  the  in- 
dividual and  of  the  public.  Individual  physicians 
are  human  beings  with  all  the  weaknesses  of  hu- 
man beings.  But  the  organized  profession  has 
always  maintained  that  the  quality  of  medical 
service,  the  safeguarding  of  the  public  health, 
and  the  destruction  of  disease  should  be  first. 
It  is  from  this  point  of  view  and  with  a record  of 
more  than  a thousand  years  of  adherence  to 
these  principles  that  organized  medicine  ap- 
proaches the  question  of  insurance. 

In  no  country  has  the  organized  medical  pro- 
fession declared  itself  against  the  principle  of 
insurance  as  a method  of  payment  for  medical 
service.  Nowhere  has  organized  medicine  based 
its  position  in  regard  to  any  medical  question 
on  economic  grounds.  The  medical  profession 
has  not  judged  sickness  insurance  simply  as  a 
means  for  removing  the  economic  obstacles  to 
securing  some  sort  of  medical  service.  On  the 
contrary,  the  medical  profession  views  sickness 
insurance  systems  and  proposals  as  a means  by 
which  lay  interests,  with  a record  that  shows  no 
such  willingness  to  relinquish  economic  advant- 
ages as  does  the  history  of  the  medical  profes- 
sion, seek  to  gain  control  of  the  practice  of 
medicine. 

Medical  associations  in  the  United  States  are 
interested  in  the  operation  of  insurance  systems 
in  all  other  countries,  not  so  much  from  the  eco- 
nomic effect  on  physicians  or  patients  (although 
this  phase  has  not  been  neglected)  but  chiefly 
with  regard  to  the  character  of  the  medical  serv- 
ice given,  its  effect  on  the  general  health  of  the 
insured  and  its  influence  on  the  standards  of 
medical  practice.  The  medical  associations  of 
insurance  countries  have  co-operated  faithfully 


March,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


179 


In  trying  to  protect  the  health  interests  of  the 
insured.  It  is  significant  that  the  advocates  of 
insurance  in  the  United  States  always  offer  as 
the  best  examples  of  insurance  just  those  sys- 
tems in  which  the  medical  associations,  always 
only  by  hard  fighting,  succeeded  in  introducing 
provisions  to  safeguard  the  character  of  the  med- 
ical service  and  to  mitigate  some  of  the  evils 
inherent  in  sickness  insurance.  It  is  also  signifi- 
cant that  the  same  advocates  oppose  all  pro- 
posals to  include  such  safeguarding  provisions  in 
the  schemes  urged  for  the  United  States. 

19.  Has  Organized  Medicine  Been  Indifferent 
to  the  Problem  of  Medical  Care  for  the  Low 
Income  Classes? 

An  estimate  based  on  numerous  though  some- 
what limited  studies  places  the  value  of  services 
donated  by  the  physicians  of  the  United  States 
to  the  care  of  the  indigents  and  low  income  class- 
es during  the  last  few  years  at  about  one  million 
dollars  a day.  Practically  every  institution  offer- 
ing service  to  these  classes  depends  for  its  exist- 
ence on  the  donated  services  of  physicians.  Re- 
ports from  many  studies  indicate  that  in  spite 
of  the  amount  of  medical  care  paid  for  at  al- 
most nominal  rates  by  the  FERA,  by  far  the 
larger  portion  of  the  care  actually  received  by 
the  unemployed  and  many  others  not  eligible  to 
FERA  benefits  during  the  past  year  was  given 
without  charge  by  physicians.  Certainly  if  there 
is  any  section  of  the  people  that  has  not  been 
indifferent  to  the  problem  of  medical  care  for 
indigents  it  has  been  the  organized  medical  pro- 
fession of  the  United  States.  State  and  county 
medical  societies  throughout  the  entire  country 
are  trying  to  find  the  best  method  of  giving  good 
medical  care  to  those  unable  to  pay  for  it.  A 
number  of  the  experiments  that  offer  the  best 
promise  of  meeting  this  situation  have  been  orig- 
inated and  are  now  being  conducted  by  such 
medical  societies.  In  all  this  discussion  and  ex- 
perimenting, the  fundamental  necessity  of  main- 
taining the  conditions  on  which  good  medical 
service  depends  has  been  kept  uppermost.  These 
experiments  have  shown  that  many  of  the  meth- 
ods of  furnishing  medical  service  by  some  of  the 
proposed  systems  destroy  the  fundamental  con- 
ditions of  good  service.  For  that  reason  or- 
ganized medicine  has  opposed  or  sharply  criti- 
cized the  wholesale  plans  offered  by  social  work- 
ers, philanthropists,  employers  and  laymen,  very 
few  of  whom  have  proved  their  devotion  to  those 
in  whose  interest  they  claim  to  act  by  any  such 
economic  sacrifice  as  has  been  made  by  mem- 
bers of  the  medical  profession. 


STATEMENT  OF  POLICY 


REPORT  OF  THE  REFERENCE  COMMITTEE 
Special  Session  House  of  Delegates  of  the 
American  Medical  Association,  Chicago, 
February  15  and  16,  1935 


Your  reference  committee,  believing  that  regi- 
mentation of  the  medical  profession  and  lay  con- 
trol of  medical  practice  will  be  fatal  to  medical 
progress  and  inevitably  lower  the  quality  of 
medical  service  now  available  to  the  American 
people,  condemns  unreservedly  all  propaganda, 
legislation  or  political  manipulation  leading  to 
these  ends. 

Your  reference  committee  has  given  careful 
consideration  to  the  record  by  the  Board  of 
Trustees  of  the  previous  actions  of  this  House 
of  Delegates  concerning  sickness  insurance  and 
organized  medical  care  and  to  the  account  of 
the  measures  taken  by  the  Board  of  Trustees  and 
the  officials  of  the  Association  to  present  this 
point  of  view  to  the  government  and  to  the 
people. 

The  American  Medical  Association,  embrac- 
ing in  its  membership  some  100,000  of  the  physi- 
cians of  the  United  States,  is  by  far  the  largest 
medical  organization  in  this  country.  The  House 
of  Delegates  would  point  out  that  the  American 
Medical  Association  is  the  only  medical  organi- 
zation open  to  all  reputable  physicians  and  es- 
tablished on  truly  democratic  principles,  and 
that  this  House  of  Delegates,  as  constituted,  is 
the  only  body  truly  representative  of  the  medical 
profession. 

The  House  of  Delegates  commends  the  Board 
of  Trustees  and  the  officers  of  the  Association 
for  their  efforts  in  presenting  correctly,  main- 
taining and  promoting  the  policies  and  princi- 
ples, heretofore  established  by  this  body. 

The  primary  considerations  of  the  physicians 
constituting  the  American  Medical  Association 
are  the  welfare  of  the  people,  the  preservation 
of  their  health  and  their  care  in  sickness,  the  ad- 
vancement of  medical  science,  the  improvement 
of  medical  care,  and  the  provision  of  adequate 
medical  service  to  all  the  people.  These  physi- 
cians are  the  only  body  in  the  United  States 
qualified  by  experience  and  training  to  guide  and 
suitably  control  plans  for  the  provision  of  medi- 
cal care.  The  fact  that  the  quality  of  medical 
service  to  the  people  of  the  United  States  to- 
day is  better  than  that  of  any  other  country  in 
the  world  is  evidence  of  the  extent  to  which  the 


180 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  10 


American  medical  profession  has  fulfilled  ifs  ob- 
ligations. 

The  House  of  Delegates  of  the  American  Med- 
ical Association  reaffirms  its  opposition  to  all 
forms  of  compulsory  sickness  insurance  whether 
administered  by  the  Federal  government,  the 
governments  of  the  individual  states  or  by  any 
individual  industry,  community  or  similar  body. 
It  reaffirms,  also,  its  encouragement  to  local  med- 
ical organizations  to  establish  plans  for  the  pro- 
vision of  adequate  medical  service  for  all  of  the 
people,  adjusted  to  present  economic  conditions, 
by  voluntary  budgeting  to  meet  the  costs  of 
illness. 

The  medical  profession  has  given  of  its  utmost 
to  the  American  people,  not  only  in  this  but  in 
every  previous  emergency.  It  has  never  required 
compulsion  but  has  always  volunteered  its  serv- 
ices in  anticipation  of  their  need. 

The  Committee  on  Economic  Security,  ap- 
pointed by  the  President  of  the  United  States, 
presented  in  a preliminary  report  to  Congress  on 
January  17  eleven  principles  which  that  Com- 
mittee considered  fundamental  to  a proposed 
plan  of  compulsory  health  insurance.  The  House 
of  Delegates  is  glad  to  recognize  that  some  of 
the  fundamental  considerations  for  an  adequate, 
reliable  and  safe  medical  service  established  by 
the  medical  profession  through  years  of  experi- 
ence in  medical  practice  are  found  by  the  Com- 
mittee to  be  essential  to  its  own  plans. 

However,  so  many  inconsistencies  and  incom- 
patabilities  are  apparent  in  the  report  of  the 
President's  Committee  on  Economic  Security 
thus  far  presented  that  many  more  facts  and  de- 
tails are  necessary  for  a proper  consideration. 

The  House  of  Delegates  recognizes  the  neces- 
sity under  conditions  of  emergency  for  federal 
aid  in  meeting  basic  needs  of  the  indigent;  it  de- 
precates, however,  any  provision  whereby  federal 
subsidies  for  medical  services  are  administered 
and  controlled  by  a lay  bureau.  While  the  de- 
sirability of  adequate  medical  service  for  crippled 
children  and  for  the  preservation  of  child  and  ma- 
ternal health  is  beyond  question,  the  House  of 
Delegates  deplores  and  protests  those  sections 
of  the  Wagner  Bill  which  place  in  the  Children's 
Bureau  of  the  Department  of  Labor  the  respon- 
sibility for  the  administration  of  funds  for  these 
purposes. 

The  House  of  Delegates  condemns  as  pernic- 
ious that  section  of  the  Wagner  bill  which  cre- 
ates a social  insurance  board  without  specifica- 
tion of  the  character  of  its  personnel  to  admin- 


ister functions  essentially  medical  in  character 
and  demanding  technical  knowledge  not  avail- 
able to  those  without  medical  training. 

The  so-called  Epstein  Bill,  proposed  by  the 
American  Association  for  Social  Security  now 
being  promoted  with  propaganda  in  the  individ- 
ual states,  is  a vicious,  deceptive,  dangerous  and 
demoralizing  measure.  An  analysis  of  this  pro- 
posed law  has  been  published  by  the  American 
Medical  Association.  It  introduces  such  hazard- 
ous principles  as  multiple  taxation,  inordinate 
costs,  extravagant  administration  and  an  inevit- 
able trend  toward  social  and  financial  bank- 
ruptcy. 

The  committee  has  studied  this  matter  from 
a broad  standpoint,  considering  many  plans  sub- 
mitted by  the  Bureau  of  Medical  Economics  as 
well  as  those  conveyed  in  resolutions  from  the 
floor  of  the  House  of  Delegates.  It  reiterates 
the  fact  that  there  is  no  model  plan  which  is  a 
cure-all  for  the  social  ills  any  more  than  there  is 
a panacea  for  the  physical  ills  that  affect  man- 
kind. There  are  now  more  than  150  plans  for 
medical  service  undergoing  study  and  trial  in 
various  communities  in  the  United  States.  Your 
Bureau  of  Medical  Economics  has  studied  these 
plans  and  is  now  ready  and  willing  to  advise 
medical  societies  in  the  creation  and  operation 
of  such  plans.  The  plans  developed  by  the  Bu- 
reau of  Medical  Economics  will  serve  the  people 
of  the  community  in  the  prevention  of  disease, 
the  maintenance  of  health  and  with  curative  care 
in  illness.  They  must  at  the  same  time  meet  ap- 
parent economic  factors  and  protect  the  public 
welfare  by  safeguarding  to  the  medical  profes- 
sion the  functions  of  control  of  medical  stand- 
ards and  the  continued  advancement  of  medical 
educational  requirements.  They  must  not  destroy 
that  initiative  which  is  vital  to  the  highest  type 
of  medical  service. 

In  the  establishment  of  all  such  plans,  county 
medical  societies  must  be  guided  by  the  ten 
fundamental  principles  adopted  by  this  House 
of  Delegates  at  the  annual  session  in  June  1934. 
The  House  of  Delegates  would  again  empha- 
size particularly  the  necessity  for  separate  pro- 
vision for  hospital  facilities  and  the  physician's 
services.  Payment  for  medical  service,  whether 
by  prepayment  plans,  installment  purchase  or  so- 
called  voluntary  hospital  insurance  plans,  must 
hold,  as  absolutely  distinct,  remuneration  for  hos- 
pital care  on  the  one  hand  and  the  individual, 
personal,  scientific  ministrations  of  the  physician 
on  the  other. 


March,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


181 


Your  Reference  Committee  suggests  that  the 
Board  of  Trustees  request  the  Bureau  of  Medi- 
cal Economics  to  study  further  the  plans  now 
existing  and  such  as  may  develop,  with  special 
reference  to  the  way  in  which  they  meet  the 
needs  of  their  communities,  to  the  costs  of  oper- 
ation, to  the  quality  of  service  rendered,  the 
effects  of  such  service  on  the  medical  profes- 
sion, the  applicability  to  rural,  village,  urban  and 
industrial  population,  and  to  develop  for  pre- 
sentation at  the  meeting  of  the  American  Medi- 
cal Association  in  June  model  skeleton  plans 
adapted  to  the  needs  of  populations  of  various 
types. 

(Signed) 

DR.  HARRY  H.  WILSON, 
Chairman,  California. 

DR.  WARREN  F.  DRAPER, 
Virginia. 

DR.  E.  F.  CODY, 
Massachusetts. 

DR.  E.  H.  CAREY, 

Texas. 

DR.  N.  B.  VAN  ETTEN, 

New  York. 

DR.  F.  S.  CROCKETT, 
Indiana. 

DR.  W.  F.  BRAASCH, 
Minnesota. 


RESOLUTIONS 

Whereas,  God  in  His  infinite  wisdom  has  taken  from 
our  midst,  Dr.  Frank  E.  Hurrle,  a beloved  fellow  mem- 
ber of  the  Pulaski  County  Medical  Society;  and 

Whereas,  Dr.  Hurrle  by  his  wise  and  sympathetic  ef- 
forts rendered  invaluable  services,  and  justly  earned  the 
gratitude  of  all  the  members,  be  it  therefore, 

Resolved,  that  in  the  death  of  Dr.  Hurrle,  we  have 
been  deprived  of  a very  valuable  friend  and  helper; 
that  we  have  lost  one  who  shed  lustre  on  our  organi- 
zation, on  the  medical  profession,  on  our  state,  and  on 
our  city,  be  it 

Resolved,  that  we  extend  to  Mrs.  Hurrle,  to  the  mem- 
bers of  the  family,  and  to  his  friends  sincere  sympathy 
in  their  hour  of  sorrow,  and  be  it  further 

Resolved,  that  as  an  expression  of  our  sympathy,  a 
copy  of  these  resolutions  be  spread  upon  the  minutes 
of  this  organization,  that  a copy  be  given  to  the  Journal 
of  the  Arkansas  Medical  Society,  and  that  a copy  be 
sent  to  Mrs.  Hurrle  and  the  members  of  the  late  Dr. 
Hurrle's  family. 

The  above  resolutions  were  passed  unanimously  by  the 
Pulaski  County  Medical  Society  in  regular  session  on 
February  4,  1935. 

M.  E.  McCASKILL,  M.  D„  Chmn. 

PAT  MURPHEY,  M.  D„ 

H.  A.  DISHONGH,  M.  D„ 

Committee. 


RESOLUTIONS 


Whereas,  God  in  His  infinite  wisdom  has  suddenly 
taken  from  us  our  friend  and  colleague,  Dr.  William  H. 
Miller;  and 

Whereas,  Dr.  Miller  endeared  himself  to  us  by  his 
genial  personality,  his  kindness,  cheerfulness,  sympathy, 
and  ever-willing  spirit  to  assist  us  in  our  difficulties; 

The  courageous  spirit  exhibited  by  him  in  continuing 
with  his  work  to  the  day  of  his  death  although  knowing 
as  he  did  that  any  moment  might  be  his  last  is  worthy 
of  our  emulation.  His  entire  lifetime  was  devoted  to 
others  and  he  has  left  us  such  a rich  heritage  of  memory 
that  we  find  it  difficult  to  realize  that  he  is  gone. 

Therefore,  Be  it  resolved,  that  the  Pulaski  County  Med- 
ical Society  in  session  assembled  express  our  apprecia- 
tion for  the  noble  work  that  Dr.  Miller  has  done;  that  we 
as  a society  feel  a sense  of  personal  loss  and  shall  ever 
cherish  his  memory. 

Be  it  further  resolved,  that  we  express  our  sympathy 
to  Mrs.  Miller  for  her  irreparable  loss;  and  that  a copy 
of  this  resolution  be  sent  to  her;  that  a copy  of  this  be 
spread  on  the  minutes  of  the  society  and  a copy  be  pub- 
lished in  the  Journal  of  the  Arkansas  Medical  Society. 

The  above  resolutions  were  pased  unanimously  by  the 
Pulaski  County  Medical  Society  in  regular  session  on 
February  4,  1935. 

M.  E.  McCASKILL,  M.  D.,  Chmn. 

PAT  MURPHEY,  M.  D„ 

H.  A.  DISHONGH,  M.  D„ 

Committee. 

<8> 

RESOLUTIONS 


Whereas,  the  Almighty  Father  of  the  Universe,  the 
Giver  of  all  good  and  perfect  gifts,  has  seen  fit  to  re- 
move from  our  midst  our  friend  and  colleague,  Dr.  Leslie 
A.  Purifoy, 

And  whereas,  the  community  has  suffered  a distinct, 
loss  and  that  his  many  admirable  qualities  and  advice 
will  be  greatly  missed  by  all, 

Now  therefore,  be  it  resolved  by  the  Union  County 
Medical  Society  and  by  the  Staff  of  the  Warner  Brown 
Hospital,  that  we  offer  to  his  father,  Dr.  W.  A.  Purifoy 
of  Chidester,  and  to  his  uncle.  Dr.  L.  L.  Purifoy,  our  deep 
appreciation  of  him  as  a man  and  as  a physician,  and 
that  express  to  them  and  to  his  family  our  profound 
sympathy  and  with  them  we  humbly  bow  our  head  in 
submission  to  the  will  of  Him  who  doeth  all  things  well. 

Be  it  further  resolved  that  a copy  of  these  resolutions 
be  spread  on  the  minutes  of  the  Society,  and  that  a copy 
be  sent  to  Dr.  W.  A.  Purifoy,  Dr.  L.  L.  Purifoy,  the  Arkan- 
sas Medical  Society,  and  the  American  Medical  Associa- 
tion. 

UNION  COUNTY  MEDICAL  SOCIETY, 

F.  O.  MAHONY, 

G.  D.  MURPHY, 

BERRY  L.  MOORE, 

Committee. 

<3, 

A preacher's  wife  gets  a raw  deal.  Clients 
don't  expect  a lawyer's  wife  to  behave  like  a 
lawyer. — Fountain  Inn,  S.  C.,  Tribune. 


182 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  10 


THE  JOURNAL 

OF  THE 

ARKANSAS  MEDICAL  SOCIETY 


Owned  by  the  Arkansas  Medical  Society  and  Published 
under  direction  of  the  Council 


DR.  W.  R.  BROOKSHER,  Editor 
610  First  National  Bank  Bldg.,  Fort  Smith,  Arkansas 


The  advertising  policy  of  this  Journal  is  governed  by  the  rules 
of  the  Council  on  Pharmacy  and  Chemistry  of  the  American 
Medical  Association. 

All  communications  to  this  Journal  must  be  made  to  it  exclu- 
sively. Communications  and  items  of  general  interest  to  the  pro- 
fession are  invited  from  all  over  the  State.  Notice  of  deaths, 
removals  from  the  State,  changes  of  location,  etc.,  are  requested. 


OFFICERS  OF  THE  ARKANSAS  MEDICAL  SOCIETY 

F O.  MAHONY,  President  El  Dorado 

M.  E.  McCASKILL,  President-Elect - Little  Rock 

A M.  ELTON,  First  Vice-President  . Newport 

S.  C.  FULMER,  Second  Vice-President  Little  Rock 

F D SMITH,  Third  Vice-President Blytheville 

R.  J.  CALCOTE,  Treasurer  Little  Rock 

W R BROOKSHER,  Secretary Fort  Smith 


COUNCILORS 

First  District— W.  M.  MAJORS  Paragould 

Second  District-S.  J.  ALLBRIGHT  Searcy 

Third  District— M.  C.  JOHN  stuttgar+ 

Fourth  District-C.  W.  DIXON  &ou'd 

Fifth  District— L.  L.  PURIFOY  El  Dorado 

Sixth  District— DON  SMITH  Hope 

Seventh  District— GEO.  B.  FLETCHER  Hot  Springs 

Eighth  District— S.  B.  HINKLE  . Little  Rock 

Ninth  District— D.  L.  OWENS  Harrison 

Tenth  District— S.  J.  WOLFERMANN  Fort  Smith 


COMMITTEES 

(Appointments  expire  in  the  year  indicated.) 

Scientific  Work— L.  L.  Purifoy,  Chairman,  El  Dorado  (1935);  R. 
B.  Robins,  Camden  (1936);  W.  R.  Brooksher,  Fort  Smith  (1937). 

Medical  Legislation — Val  Parmley,  Chairman,  Little  Rock 
(1937)-  M.  L.  Norwood,  Lockesburg  (1937);  O.  L.  Williamson, 
Marianna  (1937);  H.  T.  Smith,  McGehee  (1936);  R.  L.  Smith, 
Russellville  (1936);  A.  S.  Buchanan,  Prescott  (1935);  H.  A.  Dish- 
ongh,  Little  Rock  (1935). 

Health  and  Public  Instruction — W.  B.  Grayson,  Chairman,  Little 
Rock  ( 1 937) : S.  W.  Douglas,  Eudora  (1937);  B.  M.  Stevenson, 
Crawfordsville  (1937);  H.  K.  Carringtpn,  Magnolia  (1936);  H.  A. 
Stroud,  Jonesboro  (1936);  J.  H.  Fowler,  Harrison  (1935);  E.  J. 
Munn,  El  Dorado  (1935). 

Medical  Education  and  Hospitals — Joe  F.  Shuffield,  Chairman, 
Little  Rock  (1937);  David  Levine,  El  Dorado  (1936);  J.  B.  Futrell, 
Rector  (1935). 

Public  Relations — D.  A.  Rhinehart,  Chairman,  Little  Rock  (1937); 
E.  E.  Barlow,  Dermott  (1936);  M.  E.  McCaskill,  Little  Rock  (1935). 

Medical  Economics — I.  F.  Jones,  Chairman,  Fort  Smith  (1937); 
R.  B.  Robins,  Camden  (1937);  J.  E.  Neighbors,  Stuttgart  (1936); 
D.  E.  White,  El  Dorado  (1936);  Roy  Millard,  Dardanelle  ( 1 935) ; 
A.  C.  Shipp,  Little  Rock  (1935);  R.  M.  Sloan,  Jonesboro  (1935). 

Scientific  Exhibit — F.  H.  Krock,  Chairman,  Fort  Smith  (1935); 
H.  King  Wade,  Hot  Springs  National  Park  (1936);  W.  E.  Gray, 
Jr.,  Little  Rock  (1937). 

Arrangements — (Host  Society  1935  meeting) — D.  W.  Goldstein, 
Chairman,  C.  S.  Holt,  J.  A.  Foltz,  H.  Moulton,  M.  E.  Foster, 
W.  G.  Eberle,  I.  F.  Jones. 

Necrology — W.  H.  Mock,  Chairman,  Prairie  Grove  (1935);  J. 
M.  Lemons,  Pine  Bluff  (1936);  H.  Moulton,  Fort  Smith  (1937). 

Auxiliary — L.  J.  Kosminsky,  Chairman,  Texarkana  (1935);  W.  T. 
Wootton,  Hot  Springs  National  Park  (1936);  C.  S.  Holt,  Fort 
Smith  (1937). 

Cancer  Control — D.  W.  Goldstein,  Chairman,  Fort  Smith  (1937); 
R.  L.  Saxon,  Little  Rock  (1936);  L.  A.  Purifoy,  El  Dorado  ( 1 935 ) . 


Membership  in  the  county  medical  society  guarantees 
to  the  public,  the  law  and  the  medical  profession  that  one 
is  in  good  standing.  It  places  the  stamp  of  approval  on 
its  members.  Wherefore,  we  must  beware  that  only  the 
eligible  are  so  approved,  and  we  must  not  allow  the  in- 
eligible to  practice. — Bulletin  of  the  Medical  Society  of 
the  County  of  Kings. 


EDITORIAL 


COMPULSORY  SICKNESS  INSURANCE 

The  Special  Session  of  the  House  of  Delegates 
of  the  American  Medical  Association  held  in 
Chicago  February  15th  and  16th  has  made  em- 
phatic and  clear  the  opposition  of  organized 
medicine  to  all  forms  of  compulsory  sickness  in- 
surance and  the  regimentation  of  medicine.  The 
officers  and  trustees  deemed  it  wise  to  convene 
this  special  session  because  of  widespread,  de- 
ceptive and  insidious  propaganda  favoring  gov- 
ernmental sickness  insurance.  It  was  felt  that 
there  might  be  some  disposition  on  the  part  of 
the  component  state  associations  for  modifica- 
tion of  the  Ten-Point  Plan  adopted  at  Cleveland 
in  1934.  No  such  disposition  was  evident  among 
the  delegates,  the  report  of  the  reference  com- 
mittee being  adopted  unanimously.  Printed 
elsewhere  in  this  issue,  their  report  is  a temper- 
ate exposition  of  the  ideals  of  organized  medi- 
cine. There  can  be  no  misunderstanding  the  op- 
position with  which  medical  organization  views 
the  governmental  or  lay  supervision  and  control 
of  medical  service. 

There  is  no  claim  of  perfection  on  the  part  of 
the  profession  for  the  present  scheme  of  medi- 
cal practice.  Change  is  inevitable.  Medicine 
has  always  adapted  itself  to  the  social  and  eco- 
nomic order  in  which  it  finds  itself.  This  it  can 
continue  to  do  only  if  freed  of  politicalized  regu- 
lation and  control.  There  is  no  opposition  on  the 
part  of  the  profession  to  the  proper  study  and 
trial  of  experimental  plans  for  medical  care  in 
changed  form.  But  medicine  will  vigorously  de- 
fend its  personal  rights  which  are  ignored  by 
lay  workers  who  have  nothing  better  to  offer 
than  state  medicine. 

The  principles  formulated  by  the  American 
Medical  Association  are  economically  and  pro- 
fessionally sound.  The  way  is  left  clear  for  coun- 
ty and  state  societies  to  adopt  such  plans  as 
are  feasible,  honest,  and  fair,  for  the  provision 
of  medical  service  under  new  forms  to  such 
communities  as  may  be  in  need  of  change. 

Of  150  plans  now  under  trial,  no  one  is  ap- 
plicable on  even  a limited  national  scale.  The 
diversity  of  geographical  features,  the  distribu- 
tion of  the  population,  the  character  of  indus- 
try, and  many  other  factors  so  operate  in  this 
broad  land  of  ours  as  to  prevent  the  satisfac- 
tory functioning  of  any  one  of  these  plans  in  all 
sections. 

Of  major  importance  in  the  nation-wide  care 
of  the  ill  are  the  provisions  for  the  care  of  the 


March,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


183 


indigent,  strangely  overlooked  in  all  socialized 
plans  presented  to  date.  That  such  care  has 
been  furnished  almost  entirely  by  the  generos- 
ity of  the  medical  profession  in  the  past  may  ex- 
plain the  social  worker's  failure  to  include  these 
patients  when  arranging  for  the  care  of  the  rest 
of  the  population. 

The  medical  profession  must  now  take  an  un- 
equivocal stand.  We  must  present  a unity  of 
opinion  that  cannot  be  misunderstood  or  misin- 
terpreted. There  must  be  no  doubt  in  the  minds 
of  the  public  and  of  our  legislators  as  to  our 
undivided  stand.  This  becomes  the  duty  of  each 
county  medical  society;  of  YOU  and  I.  First, 
BECOME  INFORMED;  then  INFORM  OTHERS! 

<♦> 

EDITORIAL  COMMENT 

The  action  of  the  House  of  Delegates  of  the 
American  Medical  Association  at  its  special  ses- 
sion makes  it  imperative  that  all  physicians  be- 
come fully  informed  on  all  phases  of  sickness 
and  health  insurance.  The  Journal  has  repeated- 
ly emphasized  the  necessity  of  an  informed,  ag- 
gressive medical  profession  if  control  of  medical 
service  is  to  remain  in  professional  hands.  Coun- 
ty societies  are  requested  to  devote  a meeting 
to  a consideration  of  this  subject;  individual  mem- 
bers are  urged  to  read  all  the  available  litera- 
ture on  both  sides  of  the  question.  This  issue 
carries  "Sickness  Insurance  Catechism"  as  pre- 
pared by  the  Bureau  of  Medical  Economics  of 
the  American  Medical  Association,  previously 
distributed  in  pamphlet  form  to  the  secretaries 
of  all  county  societies.  Printed  in  The  Journal, 
it  becomes  available  to  all  members  for  a close 
study.  It  is  commended  to  you  for  thoughtful 
reading,  for  your  better  information  on  this  vital 
problem  now  facing  the  medical  profession. 

The  attention  of  county  society  secretaries  is 
called  to  the  provisions  of  the  Constitution  in 
Section  3 of  Chapter  IV:  "Each  component  coun- 
ty society  shall  be  entitled  to  send  to  the  House 
of  Delegates  each  year  one  delegate  for  every1 
twenty-five  members,  and  one  for  each  major 
fraction  thereof,  provided  that  its  annual  report 
and  assessments  are  in  the  hands  of  the  Secre- 
tary thirty  days  prior  to  the  annual  meeting." 
At  this  date,  a number  of  the  county  societies 
have  not  made  report  of  membership  while  others 
have  made  incomplete  reports.  Representation 
is  based  upon  these  reports  and  it  is  urged  that' 
every  possible  member  be  reported  as  a paid 
member  prior  to  March  15th.  There  seems  to 
be  no  valid  reason  why  the  annual  assessment 


can  not  be  paid  now  as  well  as  later  on  in  the 
year.  Prompt  payment  of  dues  is  the  obligation 
of  each  member.  The  Constitution  further  pro- 
vides that  no  member  shall  take  part  in  any  of 
the  proceedings  of  an  Annual  Session  until  he 
has  complied  with  the  provisions  of  Section  3, 
Chapter  I,  i.e.,  presents  evidence  of  1935  mem- 
bership. 



CORRECTION 

Members  are  requested  to  note  the  following 
correction  in  the  Constitution  and  By-Laws  as 
printed  in  the  February  issue  of  The  Journal.  Ar- 
ticle V should  read:  "The  House  of  Delegates 
shall  be  the  legislative  body  of  the  Society,  and 
shall  consist  of:  (I)  Delegate  elected  by  the  com- 
ponent county  societies;  (2)  the  Councilors;  and 
(3)  ex-officio,  the  President,  Secretary  and  Past- 
Presidents  of  the  Society;  provided,  however, 
that  the  Past-Presidents  shall  have  the  power  of 
voting  on  all  subjects  except  the  election  of 
officers." 

■ <s> 

COMMERCIAL  ANNOUNCEMENT 

The  Dallas  Southern  Clinical  Society  holds  its  Seventh 
Annual  Clinical  Conference  at  the  Baker  Hotel,  March 
I 8th-22n d , 1935.  The  General  Assembly  addresses  of  the 
distinguished  guest  speakers  wi  II  be  scheduled  at  8:00 
o'clock  each  morning,  followed  by  the  post-graduate 
lectures,  with  time  for  visiting  the  Technical  and  Scien- 
tific Exhibits  before  luncheon.  During  the  round  table 
luncheon  conferences,  distinguished  guests  will  answer 
questions,  followed  by  the  afternoon  hotel  clinics,  in- 
cluding the  fracture  clinic  on  Monday  by  Dr.  H.  Earle 
Conwell.  A symposium  Monday  night,  open  to  the  pub- 
lic with  Dr.  Douglas  Quick's  address  on  "Cancer,"  and 
Dr.  E.  T.  Bell  on  "Bright's  Disease,"  and  Reverend  H.  Lee 
on  "Science  and  Religion."  Tuesday  night  there  will  be 
two  symposia;  one  on  "Malignant  Disease  of  the  Head 
and  Neck,"  Dr.  Douglas  Quick,  and  the  second  on 
"Acute  Intestinal  Obstruction,"  Dr.  Waltman  Walters  and 
Wednesday  night  there  will  be  a symposia  on  "Heart 
Failure,"  Drs.  M.  Bodansky,  E.  T.  Bell  and  Louis  Hamman. 
On  Tuesday  afternoon  there  will  be  a Clinical  Pathologi- 
cal Conference  on  "Renal  Disease,"  by  Drs.  Hamman  and 
Bell,  and  on  Thursday  a Clinical  Bio-Chemical  Conference 
on  "Thyroid  Disease,"  by  Drs.  Bodansky  and  Walters. 

<S> 

ITS  QUICK  ACTION  PREVENTS  DEFORMITIES 

No  antirickatic  substance  will  straighten  bones  that 
have  become  misshapen  as  the  result  of  rickets.  But 
Mead's  Viosterol  (plain  or  in  Halibut  Liver  Oil)  can  be 
depended  upon  to  prevent  rickatic  deformities.  This 
is  not  true  of  all  antirickatic  agents,  many  of  which  are 
so  limited  by  tolerance  or  bulk  that  they  cannot  be  given 
in  quantities  sufficient  to  arrest  the  rickatic  process 
promptly,  with  the  result  that  the  bones  are  not  ade- 
quately calcified  to  bear  weight  or  muscle-pull  and  hence 
become  deformed. 


184 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  10 


PROCEEDINGS  OF  SOCIETIES 


The  annual  banquet  session  of  the  Johnson 
County  Medical  Society  was  held  January  31st 
with  G.  R.  Siegel  acting  as  toastmaster.  Dr. 
W.  R.  Hunt  gave  the  address  of  welcome  and 
the  following  scientific  program  was  presented: 
"Undulant  Fever,"  S.  C.  Fulmer,  Little  Rock,  and 
'Cellulitis,"  F.  H.  Krock,  Fort  Smith.  Guests  of 
the  Society  were:  Drs.  A.  A.  Blair,  W.  R.  Brook- 
sher,  F.  W.  Carruthers,  Robt.  Caldwell,  K.  W. 
Cosgrove,  M.  S.  Dibrell,  H.  C.  Dorsey,  Thos. 
Douglas,  M.  E.  Foster,  S.  C.  Fulmer,  L.  Gardner, 
J.  K.  Grace,  S.  C.  Grant,  A.  J.  Hansberry,  E.  J. 
Haster,  C.  S.  Holt,  Robt.  Hood,  C.  H.  Kennedy, 
C.  J.  Kirksey,  F.  H.  Krock,  M.  E.  McCaskill,  Roy 
Millard,  R.  A.  Milliken,  E.  C.  Moulton,  W.  V. 
Newman,  J.  C.  Ogden,  J.  L.  Post,  J.  F.  Shuffield, 
John  M.  Smith,  S.  P.  Stubbs,  E.  H.  White,  and  J. 
A.  Wigley. 


The  Arkansas  County  Medical  Society  met  in 
dinner  session  at  DeWitt  on  February  12th  for 
The  following  program:  "Heart  Disease,"  Joseph 
Roe,  Little  Rock,  and  "Pneumonia  in  Children," 
Dr.  Phillips,  Little  Rock. 


Carroll  County  Medical  Society  has  elected 
the  following  officers:  President,  J.  F.  John,  Eu- 
reka Springs;  Secretary-treasurer,  A.  L.  Carter, 
Berryville;  Delegate,  D.  K.  McCurry,  Green  For- 
est; and  Alternate,  R.  H.  Huntington,  Eureka 
Springs. 


Boone  County  Medical  Society  met  at  Harri- 
son on  February  I Ith,  electing  the  following  of- 
ficers: President,  J.  G.  Gladden,  Western  Grove; 
1st  Vice-president,  L.  Lloyd  Jackson,  Harrison; 
2nd  Vice-president,  G.  K.  Sims,  Harrison;  Secre- 
tary-treasurer, W.  H.  Poynor;  Delegate,  J.  H. 
Fowler,  Harrison;  Alternates,  J.  G.  Gladden  and 
W.  H.  Poynor.  Drs.  J.  Lloyd  Jackson,  Ulys  Jack- 
son  and  Henry  Kirby  of  Harrison,  and  J.  W.  Sex- 
ton, Mount  Judea,  have  been  elected  to  mem- 
bership. 

W.  H.  POYNOR,  Secretary. 


The  meeting  of  Sebastian  County  Medical 
Society  on  February  12th  was  devoted  to  a dis- 
cussion of  health  insurance  proposals  with  J.  A. 
Foltz  as  speaker. 

The  Mississippi  County  Medical  Society  was 
addressed  at  its  February  5th  meeting  by  Mem- 
phis physicians  as  follows:  "Hodgkin's  Disease," 


C.  H.  Heacock;  'Allergy  in  General  Practice," 
W.  C.  Chaney;  and  "Management  of  Conges- 
tive Heart  Failure,"  O.  T.  Warr.  Drs.  E.  H.  Cox, 
Wilson,  and  M.  L.  Cantrell,  Luxora,  were  elected 
to  membership. 

F.  D.  SMITH,  Secretary. 

Speakers  at  the  annual  Ladies'  Night  of  the 
Ouachita  County  Medical  Society  were:  Wm. 
Hibbitts,  Texarkana,  W.  R.  Thrasher  and  J.  S. 
Rinehart,  Camden,  and  Mrs.  Wm.  Hibbitts. 


E.  H.  White  and  Joe  Shuffield,  Little  Rock, 
addressed  the  Saline  County  Medical  Society  al 
a dinner  session  held  in  the  home  of  C.  W.  Jones, 
Benton,  on  February  6th. 

<$> 

EDUCATIONAL  MATERIAL  ON  CANCER 
AVAILABLE  IN  ARKANSAS 


SLIDES 

Tumors  of  the  Breast  ( medical ).  I . Dr.  H.  S.Thatcher 

2.  Dr.  Dewell  Gann,  Jr. 

Tumors  of  the  Uterus  (medical)  I . Dr.  H.  S.  Thatcher 

2.  Dr.  Dewell  Gann,  Jr. 

FILM  STRIPS 

Tumors  of  the  Breast  (medical )....  I . Dr.  D.  W.  Goldstein 

2.  Dr.  Dewell  Gann,  Jr. 
Tumors  of  the  Uterus  ( medical ).  I . Dr.  Dewell  Gann,  Jr. 
"Fight  Cancer  With  Knowledge"  I . Dr.  H.  S.  Thatcher 
(for  women's  clubs,  luncheon  2.  Dr.  Dewell  Gann,  Jr. 
clubs  and  other  lay  audiences)  3.  Dr.  D.  W.  Goldstein 
"Cancer:  Its  Life  History  and 
Practical  Measures  for  Its 

Control"  (for  university  stu-  I . Dr.  H.  S.  Thatcher 

dents,  nurses,  etc.) 2.  Dr.  D.  W.  Goldstein 

FILM  STRIP  PROJECTORS I . Dr.  H.  S.  Thatcher 

2.  Dr.  Dewell  Gann,  Jr. 

3.  Dr.  D.  W.  Goldstein 


FILM  AND  PROJECTOR  (movie) 

8-minute  Canti  film  (for  medi- 
cal profession,  medical  stu- 
dents, nurses,  etc.) I . Dr.  H.  S.  Thatcher 

SYMPOSIA  ON  TUMORS  OF 

BREAST  AND  UTERUS  I . Dr.  D.  W.  Goldstein 

Complete  program  for  county  2.  Dr.  R.  L.  Saxon 
medical  societies  on  request.. ,.3.  Dr.  L.  A.  Purifoy 

Obtainable  from: 

Dr.  H.  S.  Thatcher,  University  of  Arkansas  School  of 
Medicine,  Little  Rock. 

Dr.  Dewell  Gann,  Jr.,  215  East  6th  Street,  Little  Rock. 
Dr.  D.  W.  Goldstein,  100  South  13th  Street,  Ft.  Smith. 
Dr.  R.  L.  Saxon,  701  Main  Street,  Little  Rock. 

Dr.  L.  A.  Purifoy,  Oak  and  Cordell  Street,  El  Dorado. 
<8> 

Nature  tried  to  make  us  wise.  The  ears  stay 
open,  but  the  mouth  stays  shut  if  you  give  it  a 
chance. — Fountain  Inn,  S.  C.,  Tribune. 


March,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


185 


PERSONALS  AND  NEWS  ITEMS 


Walter  S.  Eberle,  Fort  Smith,  has  been  ap- 
pointed a member  of  the  National  Rehabilita- 
tion Committee  of  the  American  Legion. 


Geo.  F.  Jackson,  Little  Rock,  attended  a der- 
matological clinic  in  New  Orleans  during  Janu- 
ary. 


"Increased  Irritability  of  the  Gastro-lntestinal 
Tract:  A Discussion  of  Disturbed  Physiology,"  by 
B.  A.  Rhinehart,  Little  Rock,  appeared  in  the 
January  issue  of  Radiology. 

The  American  College  of  Physicians  has  elect- 
ed to  Fellowship,  Gordon  Hastings,  Little  Rock, 
and  to  Associateship,  Wm.  B.  Grayson,  Little 
Rock. 


C.  H.  Nims,  Hot  Springs  National  Park,  has 
been  re-appointed  Counselor  for  Arkansas  of  the 
Radiological  Society  of  North  America. 

At  the  organization  meeting  held  February  1st, 
The  Arkansas  Coroner's  Association  elected  the 
following  officers:  President,  Lawson  C.  Aday, 
Little  Rock;  Vice-president,  A.  S.  J.  Collins,  Mon- 
ticello,  and  Secretary-treasurer,  H.  A.  Dishongh, 
Little  Rock. 


R.  B.  Robins,  Camden,  was  elected  Vice-presi- 
dent for  Arkansas  of  the  Mid-South  Post  Gradu- 
ate Assembly  at  its  February  meeting  held  in 
Memphis. 

John  Smith,  Russellville,  is  coaching  the  Ark- 
ansas Tech  boxing  tearfi. 

The  American  Board  of  Radiology  has  certi- 
fied the  following  as  Diplomates:  W.  R.  Brook- 
sher,  Fort  Smith,  Radiology;  David  LeVine,  El 
Dorado,  Diagnostic  Roentgenology;  and  D.  A. 
Rhinehart,  Roentgenology. 

Joe  F.  Shuffield,  President  of  the  Pulaski  Coun- 
ty Medical  Society,  attended  the  recent  special 
session  of  the  House  of  Delegates  of  the  Ameri- 
can Medical  Association. 


The  Journal  offers  sympathy  to  Dr.  C.  N. 
Martin,  Warren,  in  the  loss  of  his  wife  which  oc- 
curred on  February  12th,  and  to  Dr.  J.  B.  Jame- 
son, Camden,  in  the  loss  of  his  father  on  Febru- 
ary 16th. 


C.  A.  Henry  has  resigned  as  Director  of  the 
Saline  County  Health  Unit  and  D.  W.  Fulmer,, 
Little  Rock,  has  been  placed  in  charge. 


"The  Pathology  of  Avitaminosis,"  by  Harvey 
S.  Thatcher,  Little  Rock,  appears  in  the  February 
issue  of  the  Illinois  Medical  Journal. 


M.  A.  Baltz,  Pocahontas,  has  opened  a medical 
clinic  in  the  Randolph  Hotel. 

H.  King  Wade  was  installed  as  President  of 
the  Mid-South  Post  Graduate  Medical  Assem- 
bly in  session  at  Memphis  during  February. 

J.  L.  Post,  Altus,  has  recovered  from  injuries 
received  in  an  automobile  accident  on  February 
3rd. 


A.  C.  Shipp  addressed  the  Woman's  Auxil- 
iary to  the  Pulaski  County  Medical  Society  Janu- 
ary 16th  on  "Medical  Economics." 

W.  T.  Lowe  and  J.  S.  Jenkins  have  been  elect- 
ed President  and  Secretary-treasurer,  respective- 
ly, of  the  Davis  Hospital  Staff,  Pine  Bluff. 

I.  R.  Johnson,  Blytheville,  is  taking  post-gradu- 
ate work  in  Harvard  Medical  School. 


"A  New  Type  Fracture  Band,"  by  F.  Walter 
Carruthers  appeared  in  the  January  issue  of  The 
Journal  of  Bone  and  Joint  Surgery.  This  paper 
was  presented  before  the  American  Academy  of 
Bone  and  Joint  Surgeons  in  New  York,  January 
14th. 


"The  Menorrhagias  of  Nineteen  Thirty-Three'" 
by  Drs.  Dewell  Gann,  Jr.,  and  C.  C.  Reed,  Jr., 
appears  in  the  February  issue  of  The  Mississippi 
Doctor." 


S.  J.  Wolfermann,  Fort  Smith,  and  B.  A.  Rhine- 
hart, Little  Rock,  addressed  the  Muskogee  (Okla- 
homa) Academy  of  Medicine  at  its  sessions  held 
February  26th  and  27th.  Dr.  Wolfermann  spoke 
on  "Medical  and  Surgical  Significance  of  Jaun- 
dice" and  "Recent  Advances  in  Therapy  of  Duo- 
denal Ulcer."  Dr.  Rhinehart's  subjects  were  "Hu- 
man Dietary  Requirements"  and  "Functional  Dis- 
orders of  the  Gastro-intestinal  Tract." 


Dr.  C.  A.  Henry,  formerly  Health  Director  of 
Saline  County,  is  under  treatment  at  State  Sana- 
torium. 


186 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  10 


OBITUARY 


WILLIAM  H.  MILLER,  aged  67,  a practicing 
physician  and  surgeon  of  Little  Rock  for  45  years, 
died  of  a heart  attack  at  his  home  January  24th. 
Dr.  Miller  had  been  suffering  from  a heart  ail- 
ment but  held  office  hours  and  visited  his  pa- 
tients as  usual  the  day  before  his  death.  Born 
May  8,  1867  in  Lebanon,  Tennessee,  the  son  of 
Dr.  Wesley  G.  Miller,  a physician  and  Methodist 
minister,  and  Miss  Nannie  Hamilton,  his  prelim- 
inary education  was  received  in  Tennessee  and 
Missouri  and  he  graduated  from  the  University 
of  Arkansas  School  of  Medicine  in  1888  at  the 
age  of  2 I . He  served  an  interneship  at  Bellevue 
Hospital,  New  York  City.  At  the  time  of  his 
death  he  was  professor  emeritus  of  obstetrics  of 
the  University  of  Arkansas  School  of  Medicine  as 
well  as  a member  of  the  staffs  of  the  Little  Rock 
hospitals.  He  was  a member  of  the  Pulaski 
County  and  Arkansas  Medical  Societies,  the 
Methodist  Church  and  several  hunting  clubs.  He 
is  survived  by  his  wife,  four  sisters  and  one 
brother. 


LESLIE  A.  PURIFOY,  El  Dorado,  aged  30, 
died  February  1st  of  injuries  sustained  in  an 
automobile  accident  on  January  26th.  His  con- 
dition had  not  been  considered  serious  and  his 
death  was  due  to  a coronary  embolus.  Born 
in  Chidester,  Arkansas,  the  son  of  Dr.  and  Mrs. 
W.  A.  Purifoy,  he  graduated  from  the  Camden 
High  School  and  the  University  of  Arkansas,  and 
received  his  medical  degree  from  Rush  Medical 
College  in  1930.  Following  an  interneship  at 
Michael  Reese  Hospital,  Chicago,  he  located  in 
El  Dorado  where  he  was  associated  in  practice 
with  his  uncle,  Dr.  L.  L.  Purifoy.  Active  in  or- 
ganized medicine,  he  had  served  the  Union 
County  Medical  Society  and  the  Fifth  Councilor 
District  Medical  Society  as  president,  and  was  a 
junior  member  of  the  American  College  of  Sur- 
geons. He  was  a member  of  the  Scottish  Rite 
Masons,  the  Shrine,  and  of  the  First  Baptist 
Church  of  El  Dorado.  Surviving  relatives  are 
his  parents,  Dr.  and  Mrs.  W.  A.  Purifoy,  Chides- 
ter; his  uncle,  Dr.  L.  L.  Purifoy,  El  Dorado,  and  a 
sister,  Mrs.  Joe  Mayne,  Little  Rock. 

VIRGIL  L.  PASCOE,  aged  64,  died  at  his 
home  in  Newark  January  29th.  A graduate  of 
the  Vanderbilt  University  School  of  Medicine  in 
1893,  Dr.  Pascoe  had  practiced  for  over  40 


years.  He  was  a member  of  the  Independence 
County  Medical  Society,  the  Masonic  and  Wood- 
men of  the  World  lodges.  Surviving  relatives 
are  his  wife,  three  sons  and  three  daughters. 

PHILLIP  ROSS  WATKINS,  aged  69,  died  at 
his  home  in  Mena  February  24th  of  pneumonia 
after  an  illness  of  less  than  two  weeks.  He  was  a 
graduate  of  the  Vanderbilt  University  School  of 
Medicine  in  1893  and  had  practiced  in  Mena  for 
many  years.  He  was  a past-president  of  the  Polk 
County  Medical  Society,  a member  of  the  Arkan- 
sas Medical  Society  and  of  the  Masonic  Lodge. 


The  American  Neisserian  Medical  Society  was  found- 
ed on  June  12th,  1934.  It  is  dedicated  to  the  promo- 
tion of  knowledge  in  all  that  relates  to  the  gonococcus 
and  gonococcal  infections,  that  there  may  be  attained 
improvement  in  the  management  of  gonorrhea  and  a re- 
duction in  its  prevalence. 

The  society  plans  to  carry  out  the  following  program: 

A.  The  scrutiny  of  the  management  of  gonorrhea  in 
both  male  and  female. 

B.  Clinical  and  laboratory  research  in  the  diagnosis, 
medical  and  social  pathology,  and  the  treatment  of 
gonorrhea. 

C.  Dissemination  among  the  medical  profession  and 
the  public  of  authoritative  information  concerning  gonor- 
rhea. 

Membership  is  limited  to: 

A.  Residents  of  the  United  States  or  its  territories, 
Canada  or  Mexico. 

B.  Graduates  of  a medical  school  recognized  by  the 
American  Medical  Association. 

C.  Those  who  are  engaged  in  some  phase  of  the  man- 
agement of  gonorrhea. 

Invitation  to  membership  is  extended  to  all  qualified 
physicians  who  desire  to  work  for  improvement  in  the 
management  of  gonorrhea.  Application  blanks  can  be 
obtained  from  the  undersigned. 

OSCAR  J.  COX,  Jr.,  M.  D.,  Secretary, 

475  Commonwealth  Ave., 

Boston,  Mass. 



The  Spring  Symposium  of  the  Kansas  City  Southwest 
Clinical  Society  will  be  held  in  the  President  Hotel,  Kan- 
sas City,  Missouri,  Monday,  March  II,  1935.  This  ses- 
sion will  open  a three-day  meeting,  of  which  the  last 
two  days  will  be  presented  by  the  Midwest  Section  of 
the  American  College  of  Surgeons. 

The  entire  day's  program  will  be  given  over  to  scientific 
sessions  with  presentations  by  members  of  the  society. 
Guest  speakers  who  will  also  appear  on  the  program  are 
Dr.  Irvin  Abell,  Professor  of  Clinical  Surgery,  University 
of  Louisville  Medical  School;  Dr.  Frederic  W.  Bancroft, 
Associate  Professor  of  Clinical  Surgery,  Columbia  Uni- 
versity College  of  Physicians  and  Surgeons,  and  Dr. 
Charles  L.  Scudder,  Consulting  Surgeon,  Massachusetts 
General  Hospital. 

There  will  not  be  any  registration  fee  for  this  three- 
day  meeting  which  is  open  to  the  medical  profession  at 
large. 


March,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


187 


WOMAN'S  AUXILIARY  PAGE 

MRS.  D.  W.  GOLDSTEIN 

Publicity  Secretary,  Fort  Smith 


The  Woman's  Auxiliary  to  the  Independence  County 
Medical  Society  met  February  llth  at  the  home  of  Mrs. 
F.  A.  Gray  in  Batesville.  The  following  officers  were 
elected:  President,  Mrs.  Victoria  Saylors;  Vice-president, 
Mrs.  G.  T.  Laman,  Cave  City;  Secretary,  Mrs.  C.  A. 
Churchill,  Batesville;  and  Secretary,  Mrs.  J.  M.  Hooper, 
Batesville.  The  program  was  in  honor  of  Jane  Todd 
Crawford  with  a paper  by  Mrs.  J.  M.  Hooper.  Mrs.  O. 
J.  T.  Johnson  emphasized  the  importance  of  periodic 
physical  examinations.  A salad  plate  was  served  by 
the  hostess  at  the  conclusion  of  the  meeting. 


The  Executive  Board  of  the  Woman's  Auxiliary  to  the 
Vkansas  Medical  Society  met  in  luncheon  session  at  the 
Albert  Pike  Hotel,  February  12th,  with  the  following  in 
attendance:  Mesdames  William  H ibbitts,  H.  E.  Murry, 
Marcus  T.  Smith,  Pierre  Redman,  J.  E.  Stevenson,  W.  R. 
Brooksher,  Jr.,  D.  W.  Goldstein,  J.  T.  McLain,  E.  A.  Buck- 
ey,  E.  A.  Callahan,  T.  J.  Porter,  Curtis  Jones,  P.  H. 
Phillips,  C.  E.  Kitchens,  S.  A.  Collum,  W.  T.  Wootton, 
C.  E.  Oates,  B.  A.  Rhinehart  and  J.  B.  Crawford.  Plans 
were  made  for  writing  a 10-year  history  of  the  organi- 
zation under  the  supervision  of  Mrs.  C.  W.  Garrison. 
Reports  were  given  by  county  presidents  and  commit- 
tee chairmen.  The  year  books  were  distributed  and 
minor  changes  in  the  constitution  and  by-laws  were  sug- 
gested for  adoption. 


The  Woman's  Auxiliary  to  the  Saline  County  Medical 
Society  has  elected  the  following  officers:  President,  Mrs. 
E.  A.  Buckley,  Bauxite;  1st  Vice-president,  Drs.  Dewell 
Gann,  Benton;  2nd  Vice-president,  Mrs.  F.  S.  Larkin,  Ben- 
ton; and  Secretary-treasurer,  Mrs.  Curtis  Jones,  Benton. 
The  last  meeting  was  held  February  20th  with  Mrs. 
Buckley  in  Bauxite. 


With  sorrowing  hearts,  Arkansas  and  Texas  mourn  the 
loss  of  their  most  loyal  and  capable  member,  Mrs. 
Preston  Hunt,  whose  death  occurred  January  27th  in 
Texarkana. 

Mrs.  Hunt  was  President  of  the  Woman's  Auxiliary  to 
the  Texas  State  Medical  Society  and  an  active  member 
of  the  Woman's  Auxiliary  to  the  Arkansas  State  Medical 
Society. 

Our  most  sincere  sympathy  to  Doctor  Hunt,  the 
Woman's  Auxiliary  to  the  Texas  State  Medical  Society, 
and  the  Woman's  Auxiliary  to  the  Bowie  and  Miller 
County  Medical  Society. 


The  Woman's  Auxiliary  to  the  Sebastian  County  Med- 
ical Society  sponsored  an  open  Public  Relations  meet- 
ing for  women  at  the  Senior  High  School  February  I Ith. 
Dr.  Ruth  Ellis,  Fayetteville,  spoke  on  "What  Women 
Should  Know  About  Cancer."  Dr.  Louise  Henry  of  Fort 
Smith,  discussed  "Preventative  Measures  in  Children's 
Diseases."  A motion  picture  film,  "Fighting  Cancer  with 
Knowledge,"  was  presented.  Mrs.  Wm.  Hibbitts,  Presi- 


dent of  the  Woman's  Auxiliary  to  the  Arkansas  Medical 
Society,  was  an  honor  guest. 


The  Woman's  Auxiliary  to  the  Johnson  County  Medical 
Society  met  at  the  home  of  Mrs.  G.  L.  Hardgrave  Janu- 
ary 22nd.  Annual  dues  and  monthly  dues  to  apply  on 
the  Oates  Student  Loan  Fund  were  collected. 

Mrs.  G.  R.  Siegel  entertained  with  a lovely  dinner 
party  at  her  home  on  January  31st.  Out  of  town  guests 
were  Mrs.  E.  J.  Haster  and  Mrs.  Roy  Millard,  of  Darda- 
nelle,  and  Mrs.  Robert  Hood,  of  Russellville,  who  accom- 
panied their  husbands  to  Clarksville  to  attend  the  an- 
nual banquet  of  Johnson  County  Medical  Society. 


The  Woman's  Auxiliary  to  the  Bowie-Miller  County 
Medical  Society  was  entertained  January  llth  by  Mrs. 
Joe  E.  Tyson,  Mrs.  Albert  Mann,  Dr.  Francis  Spinks  and 
Mrs.  E.  L.  Beck  at  the  home  of  Mrs.  Tyson.  Mrs.  Decker 
Smith,  president,  conducted  the  business  routine  after 
which  Mrs.  L.  H.  Lanier,  program  leader,  gave  an  illumi- 
nating resume  of  "Latest  Advancements  in  Medicine." 


The  Washington  County  Medical  Auxiliary  met  Janu- 
ary 8th  at  the  Washington  Hotel.  The  following  officers 
were  elected:  Mrs.  Loyce  Hathcock,  President;  Mrs.  J. 
W.  Walker,  Vice-President,  and  Mrs.  Fount  Richardson, 
Recording  Secretary  and  Publicity  Chairman. 


The  Woman's  Auxiliary  to  Pulaski  County  Medical  So- 
ciety met  on  January  16th  at  the  home  of  Mrs.  J.  Palmer 
Sheppard  with  the  president,  Mrs.  J.  B.  Crawford,  pre- 
siding. Assistant  hostesses  were  Mrs.  J.  B.  Crawford, 
Mrs.  B.  A.  Rhinehart,  Mrs.  Hoyt  Allen  and  Mrs.  Glenn 
Johnson.  Other  members  present  were  Mrs.  C.  E.  Oates, 
Mrs.  H.  A.  Higgins,  Mrs.  W.  E.  Gray,  Sr.,  Mrs.  D.  M. 
Switzer,  Mrs.  Pat  Murphey,  Mrs.  C.  C.  Reed,  Mrs.  W.  N. 
Freemyer,  Mrs.  S.  C.  Fulmer,  Mrs.  K.  W.  Cosgrove,  Mrs. 
E.  H.  White,  Mrs.  W.  A.  Snodgrass,  Mrs.  W.  L.  Sadler, 
and  Mrs.  W.  R.  Richardson.  Special  guests  at  the  meet- 
ing were  Mrs.  J.  T.  McLain,  of  Gurdon,  state  chairman 
of  the  Education  and  Public  Health  Committee,  and  presi- 
dents of  the  affiliated  clubs  of  the  City  Federation.  Among 
the  guests  were  Mi^s  Gertrude  Remmel,  Miss  E.  Wort- 
smith,  Mrs.  Lester  G.  McAllister,  Mrs.  W.  G.  Browne, 
Mrs.  F.  J.  Wills,  Mrs.  M.  W.  Muldron,  Mrs.  George  C. 
Branner  and  Mrs.  L.  Y.  Cohen.  Dr.  A.  C.  Shipp  spoke 
on  "Medical  Economics." 


The  Obstetrical  Pack  Committee,  Woman's  Auxiliary 
to  the  Pulaski  County  Medical  Auxiliary,  met  at  the  home 
of  Mrs.  K.  W.  Cosgrove  with  the  following  members  at- 
tending in  the  work:  Mesdames  F.  E.  Hurrle,  T.  B.  Craw- 
ford, B.  A.  Bennett,  C.  E.  Oates,  M.  E.  McCaskill,  D.  M. 
Switzer,  R.  A.  Law,  W.  R.  Richardson,  W.  H.  Miller,  G. 
F.  Jackson,  H.  A.  Higgins,  W.  E.  Gray,  W.  A.  Snod- 
grass and  B.  A.  Rhinehart. 


188 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  10 


BOOK  REVIEWS 


Nature's  Way.  By  Victor  Cox  Pederson,  M.  D,  Pp.  74. 
Price  $1.00.  New  York:  G.  P.  Putnam's  Sons  and  Min- 
ton, Balch  & Company,  1934. 

The  author  describes  the  so-called  fertile  period  of  the 
menstrual  cycle  as  based  upon  the  works  of  Ogino  and 
Knaus.  It  affords  a thorough,  simple  explanation  of  the 
process  of  conception  and  the  fertile  and  sterile  periods. 
It  is  written  for  the  lay  public  but  will  be  of  interest  to 
the  physician. 


Report  on  Seventh  International  Congress  of  Military 
Medicine  and  Pharmacy,  Madrid,  Spain,  May-June,  1933. 

By  William  Seaman  Bainbridge,  Captain,  M.  C.-F.,  U.  S. 
Naval  Reserve,  Member  of  Permanent  Committee,  Dele- 
gate from  the  United  States.  Pp.  88.  Menasha,  Wiscon- 
sin: George  Banta  Publishing  Company,  1934. 

A concise  abstract  of  the  proceedings  of  the  Congress 
is  presented.  The  subjects  reported  upon  at  the  Congress 
were:  ( I ) General  principles  regarding  medical  services 
in  war  time;  their  application  to  the  new  rulings  of  the 
Geneva  Convention,  (2)  Preventitive  vaccination  in  the 
army,  navy  and  air  force,  (3)  Treatment  in  the  advanced 
posts  of  urgent  surgical  casualties  in  a war  of  movement, 
(4)  Preserved  foods  as  a regular  ration  for  soldiers  in 
peace  time  or  in  the  field,  their  mode  or  preparation  and 
analysis,  (5)  Comparative  study  of  the  dental  and  ad- 


ministrative services  in  the  different  armies,  navies  and 
air  forces,  and  (6)  Veterinary  section  studies.  The  book 
is  of  particular  interest  +o  the  medical  officer  of  the 
armed  forces  of  the  country. 


Hughes'  Practice  of  Medicine.  15th  Edition.  Revised 
and  edited  by  Burgess  Gordon,  M.  D.,  with  Sections  on 
Nervous  and  Mental  Diseases  by  Harold  D.  Palmer,  M.  D., 
and  on  Diseases  of  the  Skin  by  Vaughn  C.  Garner,  M. 
D.  Pp.  808.  Price  $5.00.  Philadelphia:  P.  Blakiston's 
Son  and  Co.,  1935. 

This  volume  is  a comprehensive  consideration  in  concise 
form  of  a great  majority  of  the  more  common  condi- 
tions met  in  the  practice  of  medicine.  The  subject  mat- 
ter is  well  arranged,  intelligently  written  and  assembled, 
and  each  subject  is  fully  covered.  All  the  more  recent 
advances  have  been  included  in.  this  new  edition.  It  is 
a handy  volume  for  instruction  or  reference. 


Body  Mechanics.  By  Joel  E.  Goldthwait,  M.  D.,  LL.D.. 
Member  of  board  of  consultants,  Massachusetts  General 
Hospital,  Ex-pres.,  American  Orthopedic  Association; 
Lloy  T.  Brown,  Instructor,  Orthopedic  Surgery,  Harvard 
Medical  School;  and  John  G.  Kuhns,  Asst,  in  Orthopedic 
Surgery,  Harvard  Medical  School.  Pp.  281.  99  illustra- 

tions. Price  $4.00.  Philadelphia:  J.  B.  Lippincott  Com- 
pany, 1934. 

The  authors  have  endeavored  to  show  that  for  the  hu- 
man body  to  be  as  it  should,  all  parts  must  perform  in 


ACTUAL  PRACTICE  IN  SURGICAL  TECHNIQUE 

WITH  A REVIEW  OF  SURGICAL  ANATOMY 

For  information  as  to  Courses,  Fees,  Registration  requirements,  etc.,  address 
CHICAGO  INSTITUTE  OF  SURGERY 
2040  LINCOLN  AVE.  CHICAGO,  ILL. 


GRANITE  MOUNTAIN  HOSPITAL 

| ... 

Open  to  All  Reputable  Physicians  and  Surgeons 

S.  P.  JUNKIN,  M.  D.,  Medical  Director 

Telephone  Rural  9579-F2  Route  4,  Little  Rock,  Ark. 

HHBH 

ALCOHOLISM  - MORPHINISM 

Successfully  Treated  by  Dr.  B.  B.  Ralph's  Methods 

SCIENTIFICALLY  equipped  for  Diagnostic  Surveys,  Thera- 

s I HHIp  H 

peutic  Procedures,  Rest  and  Recuperation.  Treatment  of 

each  case  established  by  clinical  history,  physical  exam- 
ination, laboratory  tests  and  individual  tendencies. 

Reasonable  fees. 

•tit  Y'ears  Established 

Address  THE  RALPH  SANITARIUM, 

RALPH  EMERSON  DUNCAN.  M.  D. 

529  HIGHLAND  AVENUE,  KANSAS  CITY,  MO. 

Director. 

Telephone,  Victor  4850. 

March,  1935] 


ARKANSAS  MEDICAL  SOCIETY' 


189 


the  proper  relationship.  The  anatomic  and  physiologic 
features  as  presented  in  the  chronic  patient  are  stressed 
to  the  general  practitioner,  the  diagnostician  and  to 
the  surgeon.  Genral  conceptions  and  considerations 
of  body  types,  arthritis,  and  the  part  played  by  dis- 
eases of  the  abdominal  viscera,  the  circulatory  system 
and  the  nervous  system,  are  fully  discussed.  Treatment 
is  widely  discussed  with  special  reference  to  chronic 
disease.  The  chapter  dealing  with  backache  contains 
sound  fundamental  facts.  The  authors  emphasize  the 
fact  that  arthritis  is  not  primarily  a disease  of  the 
joints  alone,  but  that  it  is  a systemic  affair,  and  show 
that  body  posture  or  body  mechanics  play  an  import- 
ant part  in  the  etiology  and  treatment  of  the  condi- 
tion. The  authors  are  to  be  congratulated  for  the 
presentation  of  this  timely  volume. 


The  1934  Yearbook  of  General  Medicine.  Edited  by 
George  F.  Dock,  Lawrason  Brown,  Geo.  R.  Minot,  W. 
B.  Castle,  W.  D.  Stroud  and  G.  B.  Eusterman.  Pp. 
843.  Price  $3.00.  Chicago:  The  Yearbook  Publish- 
ers, 1934. 

The  literature  pertaining  to  general  medicine  dur- 
ing the  year  has  been  excellently  summarized.  This 
volume  is  of  particular  value  to  those  physicians  whose 
time  for  reading  is  limited.  A clear,  bird's-eye  view 
is  given  of  the  literature  on  infectious  diseases  and 
those  of  the  chest,  blood  and  blood-forming  organs, 
the  kidneys,  the  heart,  the  digestive  system  and  of 
metabolism.  It  is  a worth-while  volume  for  any  one: 
a post-graduate  course  in  these  subjects. 


Electrocardiography.  By  Chauncey  C.  Maher,  B.  S., 
M.  D.  Assistant  Professor  of  Medicine,  Northwestern 
University  and  the  Montgomery  Ward  Medical  Clinics; 
Attending  Internist  at  the  Cook  County  Infirmary  and 
the  Cook  County  Hospital  and  the  Passavant  Memo- 
rial Hospital,  Chicago,  Illinois.  Baltimore:  William 
Wood  & Company,  1934. 

This  treatise  on  electocardiography  is  a text  that 
can  be  well  recommended  to  either  the  general  prac- 
titioner, student  or  specialist  in  heart  disease;  written 
in  such  a manner  that  they  may  learn  the  value  of  the 
electrocardiogram  in  the  diagnosis  of  cardiac  disease, 
and  classification  of  cardiac  arrthymias  and  the  con- 
their  clinical  data. 

Chapters  II  and  III,  devoted  to  a brief  discussion 
and  classification  of  cardiac  arthymias  and  the  con- 
duction system  as  a whole,  are  dealt  with  in  a splendid 
manner. 

This  text  follows  on  through  with  schematic  draw- 
ings and  electrocardiographic  tracings  taken  up  in- 
dividually, with  a wholesome  systematic  interpretation 
of  the  electrocardiogram  well  worth  any  one  following. 
Certainly  this  type  of  interpretation  and  conclusions 
arrived  at  is  quite  valuable  to  the  average  physician 
who  is  not  adept  in  this  field  of  work. 


IRRITATION 

as  influenced  by  Hygroscopic  Agents 

"T  T is  obvious  that  the  cigarettes 
which  had  been  made  with 
diethylene-glycol  as  hygroscopic 
agent  proved  to  be  less  irritating 
than  those  with  no  hygroscopic 
agent,  and  much  less  irritating 
than  those  with  glycerine*” 

r' Influence  of  Hygroscopic  Agents  it 
on  Irritation  from  Cigarette  Smoke.” 

Proc.  Soc.  Exp.  Biol,  and  Med.,  1934, 
32,  241-245. 


Philip  Morris  cigarettes,  use  only 
diethylene-glycol,  as  the  hygroscopic 
agent.  To  any  doctor  who  wishes  to 
test  them  for  himself  the  Philip  Morris 
Company  will  gladly  mail  a sufficient 
sample  on  request  below.  * * 


190 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  10 


How  to  Practice  Medicine.  By  Henry  W.  Kemp,  M.  D. 
Pp.  146.  Price  $2.50.  Paul  B.  Hoeber,  Inc.,  New  York, 
1934. 

This  book  is  written  with  the  view  of  keeping  the  be- 
ginner from  making  avoidable  mistakes  in  his  earlier  days 
of  practice.  Of  some  interest  to  all  medical  men,  the 
volume  is  written  especially  for  senior  medical  students, 
recent  graduates  and  internes. 


— is  secondary  to  its  importance  as  a body-building  food 
with  vitamins. 

An  interesting  booklet  about  the  origin  and  function 
of  all  the  accepted  vitamins  has  been  prepared  by  R.  B. 
Davis  Company,  the  makers  of  Cocomalt.  It  may  be 
secured  on  request  without  cost  by  writing  the  company 
at  Hoboken,  New  York,  Dept.  000. 


In  as  much  detail  as  the  space  permits  the  author  has 
set  down  advice  covering  many  problems  likely  to  be  en- 
countered in  setting  up  practice.  He  has  included  sev- 
eral points  of  medical  ethics,  and  shows  the  importance 
of  keeping  the  patients  satisfied.  The  book  contains 
several  "useful  prescriptions,"  and  other  therapeutic 
points  are  also  discussed  at  intervale. 

Although  the  volume  propounds  much  of  the  personal, 
thus  losing  in  general  application,  it  is  permeated  with 
the  dictates  of  common  sense,  and  hence  may  at  the 
least  afford  pleasant  reading  to  prospective  practition- 
ers. 

A food  product  is  available  containing  sufficient  vita- 
min D so  that  it  is  unnecessary  to  go  to  the  expense  of 
buying  vitamin  D preparations  to  supplement  the  diet. 
For,  according  to  clinical  tests,  Cocomalt,  when  taken 
three  times  a day,  will  supply  children  with  enough  vita- 
min D.  Cocomalt  contains  not  less  than  30  Steenbock 
(81  U.  S.  P.  revised)  units  per  ounce — the  amount  used 
to  make  one  drink.  Cocomalt  is  licensed  by  the  Wis- 
consin University  Alumni  Research  Foundation.  Ordi- 
narily vitamin  D preparations  are  unpalatable,  but  in 
this  form  its  existence  is  unsuspected. 

In  addition  to  its  importance  as  a vitamin  D supple- 
ment to  the  diet,  Cocomalt  is  helpful  where  milk  intake 
is  a problem.  For  Cocomalt,  which  is  designed  to  be 
mixed  with  milk,  is  truly  delicious.  But  a word  of  warn- 
ing must  be  sounded  concerning  products  that  appear  to 
be  similar  to  Cocomalt.  For  the  most  part  these  prepara- 
tions are  mere  flavorings — a mixture  of  chocolate  and 
sugar.  Cocomalt,  however,  is  a product  designed  as  a 
food  with  vitamin  content.  Its  tempting  chocolate  flavor 
— important  as  it  may  be  in  making  milk  more  palatable 


SQUIBB  HALIBUT-LIVER  OIL  CONCENTRATE 
TABLETS  WITH  VIOSTEROL  250-D 


A new  product  that  has  just  been  released  by  the 
Squibb  Laboratories  is  Squibb  Halibut-Liver  Oil  Con- 
centrate Tablets  with  Viosterol  250-D.  These  highly  po- 
tent, chocolate-coated  tablets  will  be  prescribed  by  physi- 
cians as  an  alternative  means  of  administering  the  vita- 
mins of  Viosterol-fortified  Halibut-Liver  Oil. 

Each  tablet  equals  in  Vitamin  A and  D potency,  10 
drops  (approximately  10  mins.),  of  Squibb's  Stabilized 
Halibut-Liver  Oil  with  Viosterol  250-D.  The  vitamin-po- 
tency of  the  tablets  is  protected  by  the  same  methods 
that  have  been  found  to  be  so  successful  in  affording 
similar  protection  in  the  manufacture  of  Adex  Tablets. 


CIGARETTE  SMOKE 


Michael  S.  Mulinos  and  Raymond  L.  Osborne.  Phar- 
macology of  Inflammation:  III.  Influence  of  Hygroscopic 
Agents  on  Irritation  from  Cigarette  Smoke.  Proc.  Soc. 
Exp.  Biol.  & Med.,  1934,  32,  241-245.  A successful  at- 
tempt to  measure  objectively  the  irritant  properties  in 
cigarette  smoke  is  reported.  The  method  used  was  that 
described  by  Hirschhorn  and  Mulinos:  Proc.  Soc.  Exp. 
Biol.  & Med.,  1930,  28,  168.  A study  of  the  influence  of 
hygroscopic  agents  on  the  edema  produced  on  the  con- 
junctiva of  rabbits  is  given.  The  hygroscopic  agents  most 
commonly  used  in  cigarettes  are  gylcerine  and  diethylene 
glycol.  It  was  stated  that  "It  is  is  obvious  that  the  cigar- 
ettes which  have  been  made  with  diethylene  glycol  as  hy- 
groscopic agent  prove  to  be  less  irritating  than  those- 
with  glycerine." 


IfiSn 


c A D 

worth  what  you  and  other  members 


onize  this  Journal  you  protect  your- 
lcrease  the  value  of  the  Journal  for 


\s  are  not  accepted  unless  approved 
hemistry  of  the  American  Medical 


pe  in  the  Journal.  The  majority  of 
it  patrons  secure  good  results. 

AS  MEDICAL  SOCIETY 


THE  JOURNAL 

^ of  the  ARKANSAS  MEDICAL  SOCIETY  ^ 

PUBLISHED  MONTHLY  UNDER  DIRECTION  OF  THE  COUNCIL 
Vol.  XXXI  FORT  SMITH,  ARKANSAS,  APRIL,  1935  No.  I I 


CARCINOMA  OF  THE  UTERUS  AND 
TREATMENT* 

W.  DECKER  SMITH,  B.  S.,  M.  D.,  F.  A.  C.  S. 
Texarkana 


In  presenting  the  subject  I have  chosen  for  this 
occasion,  I realize  very  well  the  multitude  of 
material  in  such  a title.  My  remarks  will  be  con- 
fined to  cancer  of  the  cervix  and  of  the  uterus 
in  general.  Reviewing  the  mortality  rates  as 
furnished  by  the  United  States  Census  Bureau, 
one  cannot  but  realize  the  terrible  task  con- 
fronting the  medical  profession  in  the  cure  and 
control  of  this  disease.  Cancer  is  second  only 
to  heart  disease  in  the  causes  of  death  today, 
occupying  the  position  that  tuberculosis  did 
thirty  years  ago. 

It  is  generally  accepted  that  cancer  is  a proc- 
ess characterized  by  an  unrestrained  cell  growth. 
This  growth  seems  to  start  at  one  or  more  focal 
points  and,  in  many  instances,  to  be  preceded  by 
a phase  of  relatively  long  duration  during  which 
the  cells  are  acted  upon  by  something  associat- 
ed with  a process  of  chronic  irritation  producing 
a cellular  hyperplasia.  In  it's  incipiency  cancer  is 
generally  localized  but  sooner  or  later  it  spreads 
by  invasion  of  surrounding  tissues  at  the  expense 
of  normal  cell  growth  and  function. 

The  early  stages  of  cancer  growth  are  rarely 
associated  with  symptoms,  and  unless  neoplasms 
happen  to  be  external  and  can  be  seen  or  felt, 
their  existence  remains  long  unsuspected.  It  is 
the  slow,  insidious  onset  that  produces  the  trage- 
dies we  see  in  the  treatment  of  this  disease  to- 
day. 

In  most  of  the  countries  where  statistics  are 
reliable,  cancer  of  the  uterus  is  one  of  the  most 
frequent  causes  of  cancer  mortality  in  females. 
In  England  it  is  only  exceeded  by  cancer  of  the 
breast  and  in  the  United  States  it  is  the  most 
frequent  cause  of  death  in  the  female.  The  death 
rate  in  these  various  countries  is  almost  station- 

*  Read  before  the  Fifty-ninth  Annual  Session  of  the 
Arkansas  Medical  Society,  held  in  Little  Rock,  April  16- 
'8,  1934. 


ary  and  the  tremendous  efforts  which  have  been 
concentrated  upon  prophylaxis,  early  recogni- 
tion and  treatment  have  had  little  effect  on  it. 
Garnick  (1929)  remarks  that  the  proportion  of 
inoperable  cases  coming  to  the  Frankfort  Gnye- 
cological  Clinic  remains  at  45%,  exactly  the 
same  as  it  was  in  1919. 

From  the  facts  we  have  learned  about  the 
causes  of  malignancies  of  the  cervix  and  uterus, 
there  can  be  little  doubt  but  that  cervical  ero- 
sions, chronic  endo-cervicitis  and  the  injuries 
which  occur  during  delivery  are  contributory 
causes  for  cancer  of  these  organs.  These  facts 
are  borne  out  by  the  statistical  studies  of  O'Brien, 
Farrer,  Crosson  and  others.  The  important  pre- 
cancerous  factor  in  chronic  endo-cervicitis  is  epi- 
thelial hyperplasia.  The  common  gross  changes 
in  the  cervix,  resulting  from  endo-cervicitis,  ac- 
cording to  Farrar  and  Novak,  are  erosion  and 
eversion  of  the  cervical  lips,  cystic  changes,  ab- 
normal discharge  and  occasionally,  bleeding.  Dif- 
ferentiation between  this  condition  and  cancer 
may  be  impossible  except  by  microscopic  study. 
Leukoplakia,  first  described  by  Von  Franque  in 
1907  and  recently  by  Hinselman,  who  feels  that 
when  it  is  found  amputation  of  the  cervix  is  in- 
dicated because  it  is  an  almost  sure  precursor 
of  cancer.  Smith  and  Grinnell  are  of  the  opinion 
that  retention  of  material  within  the  uterus  is  a 
frequent  etiological  factor  in  corpus  carcinoma. 
In  their  series  of  101  cases  of  carcinoma  of  the 
body  of  the  uterus,  41  cases  show  definite  evi- 
dences of  improper  drainage  and  the  retention 
of  various  materials.  There  still  remains  con- 
siderable doubt  just  what  part  fibroma  of  the 
uterus  play  in  the  production  of  malignancy. 
Davis,  Smith,  Lacy  and  Klaus  have  expressed  their 
belief  that  carcinoma  of  the  body  occurs  pro- 
portionately more  frequent  in  women  with  fibro- 
myomas. 

It  is  apparently  firmly  established  that  uterine 
cancer  is  much  less  common  in  the  Hebrew  race 
than  in  any  other  according  to  statistical  data 
furnished  by  Sorsby  in  1931.  The  age  at  which 
cancer  of  the  cervix  and  body  of  the  uterus  oc- 
curs varies  considerably.  According  to  Lane  and 


192 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  I I 


Claypon,  the  mean  age  of  women  applying  to 
hospitals  for  treatment  is  45  to  75  years.  29.3% 
of  their  cases  were  under  40,  which  bears  out  the 
general  belief  that  the  disease  has  little  relation 
to  the  menopause.  Carcinoma  of  the  body  of 
the  uterus  is  most  frequently  present  after  50. 
Donner  and  Shaw  believe  no  unquestionable  cas- 
es of  carcinoma  of  the  body  occur  before  the 
fortieth  year. 

Anatomically,  carcinoma  is  classified  according 
to  location  as  follows: 

(1)  Carcinoma  of  the  vaginal  portion  of  the 
cervix,  that  portion  between  the  external  os  and 
vaginal  vault. 

(2)  Carcinoma  of  cervical  canal,  bounded  be- 
low by  external  os  and  above  by  the  internal  os. 

(3)  C arcinoma  of  the  mucous  membrane  lining 
the  uterine  cavity  from  the  internal  os  to  the 
fundus. 

Histologically,  carcinoma  is  classified  as  fol- 
lows: 

(1)  Squamous  cell  carcinoma. 

(2)  Cylindrical  cell,  or  adeno-carcinoma. 

(3)  Epithel  ioma  and  adeno-carcinoma  (uncom- 
mon.) 

Squamous  cell  cancer  nearly  always  develops 
in  the  epithelial  covering  of  the  vaginal  portion 
of  the  cervix,  but  in  rare  instances  it  has  been 
found  in  the  endometrium  of  the  uterine  body. 
The  origin  here  has  been  attributed  to  the  pres- 
ence of  cell  inclusion,  but  recent  investigation 
tends  to  prove  that  it  is  more  probably  the  re- 
su  It  of  metaplasia  of  the  surface  epithelium. 
Cylind  rical  cell  cancer  of  the  cervical  canal  orig- 
inates in  the  cells  covering  the  endo-cervix,  or 
in  the  cells  of  the  cervical  glands.  Carcinoma 
of  the  body  is  nearly  always  of  the  cylindrical 
cell  variety,  originating  in  the  surface  or  glandu- 
lar epitheli  urn.  Of  the  various  anatomical  varie- 
ties, carcinoma  of  the  cervix  is  by  far  the  most 
frequent,  constituting  about  90%  of  the  cases. 

There  are  certain  diagnostic  criteria.  In  order 
of  frequency  and  importance  they  are  as  fol- 
lows: 

(I)  Bleeding,  occurring  irregularly  about  the 
menopause  should  always  be  looked  upon  with 
suspicion.  So  many  patients  attribute  these 
changes  to  the  menopause,  and  quite  frequently 
they  are  based  upon  advice  from  the  family 
physician,  which,  in  many  instances,  has  robbed 
these  unfortunate  individuals  of  a chance  for 
cure.  Bleeding  arising  months  or  years  after  the 
menopause  is  most  suggestive  as  post-climateric 


bleeding  rarely  ever  occurs  in  any  other  condi- 
tion. 

(2)  The  discharge  present  in  the  early  stages 
is  watery  and  serosanguinent,  described  by  some 
as  a "beefy,  watery  discharge."  The  special 
character  of  this  material  is  of  utmost  signifi- 
cance. In  the  later  stages,  after  sloughing  of 
the  tumor  mass  and  secondary  infection  takes 
place,  the  discharge  becomes  purulent  and  ex- 
ceedingly foul. 

(3)  Pain  is  rather  a late  symptom  and,  most  un- 
fortunately, indicates  an  advanced  stage  of  the 
disease  with  involvement  of  the  parametrial  tis- 
sues and  nerve  endings. 

(4)  Bladder  and  bowel — As  infiltration,  exten- 
sion, and  widespread  involvement  of  cervix  and 
vaginal  wall  takes  place,  the  bladder  and  bowel 
become  involved.  There  may  be  dysuria,  reten- 
tion, constipation  and  rectal  pain.  As  the  disease 
progresses,  either  vesical  or  recto-vaginal  fis- 
tula or  both  may  occur. 

Metastasis,  as  a rule,  occurs  late,  the  regional 
lymph  nodes  probably  being  the  most  promi- 
nent site  and  next  in  frequency,  the  liver,  ovary 
and  pertitoneum.  Warren,  in  a recent  statis- 
tical survey  on  metastasis,  shows  that  the  higher 
the  grade  of  malignancy,  the  more  generalized 
becomes  the  metastasis. 

The  most  recent  advance  in  the  early  diagno- 
sis of  squamous  cervical  carcinoma,  which  con- 
stitutes about  85  or  90  per  cent  of  the  cases, 
has  been  made  by  Schiller  of  Vienna.  This  test 
is  known  as  the  Lugol's  solution  test.  It  is  based 
on  the  fact  that  normal  vaginal  mucous  mem- 
brane contains  a rich  supply  of  glycogen,  differ- 
ing considerably  from  that  glycogen  found  in 
the  liver,  muscles  and  other  organs  in  that  it  is 
not  soluble  in  water.  The  test  is  made  by  apply- 
ing Lugol's  solution  to  the  cervix  and  vagina 
with  a well  saturated  sponge  or  tampon  for  one 
to  two  minutes,  after  which  the  excess  amount 
is  removed  by  gentle  sponging.  In  areas  in 
which  the  test  is  positive  there  is  an  absence  of 
the  dark  mahogany  stain,  showing  as  unstained 
spots.  There  are  four  conditions,  according  to 
Schiller,  which  will  not  take  the  stain:  . 

(1)  Carcinomatous  layers  or  incipient  carci- 
noma. 

(2)  The  presence  of  hyperkeratosis  as  a result 
of  prolapse  of  the  uterus. 

(3)  The  presence  of  hyperkeratosis  as  the  re- 
sult of  luetic  infection. 

(4)  The  desquamation  of  the  upper  layers  of 
glycogenous  epithelium  from  trauma. 


April,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


193 


The  negative  test  is  most  certain  that  carci- 
noma is  not  present  in  the  cervix.  The  test  is 
most  valuable  in  biopsy.  In  Schiller’s  routine  use 
of  this  test,  he  was  able  to  recognize  the  early 
stages  of  the  disease  and  apply  the  proper  treat- 
ment with  a resulting  percentage  of  cures  of  90- 
95%.  The  advantage  of  the  test  is  its  simplic- 
ity. It  can  be  performed  by  any  physician  and 
will  aid  materially  in  the  early  recognition  of  this 
disease.  It  is  useful,  however,  only  in  the  early 
recognition  of  cervical  carcinoma.  The  negative 
test  does  not  preclude  absence  of  malignancy 
from  the  cervical  canal  or  uterine  cavity.  In 
these  cases  with  the  suspicion  of  malignancy, 
curretage  is  indicated. 

For  improvement  of  the  morbidity  and  mor- 
tality of  this  disease,  the  medical  profession  as 
well  as  the  layman,  must  be  awakened  to  the 
fact  that  the  disease  is  curable  in  its  early  stages, 
and  that  all  precancerous  lesions,  the  result  of 
disease  or  injury,  must  be  corrected  if  the  dis- 
ease is  to  be  controlled.  This  calls  for  consider- 
able education  of  the  public  on  the  early  symp- 
toms of  the  disease  and  of  the  importance  of 
early  treatment  if  cures  are  to  be  obtained. 

In  the  beginning,  radical  surgical  removal  is 
the  procedure  of  choice.  It  is  estimated  that 
about  40%  of  the  cases  are  operable  when 
first  examined.  Of  these,  about  10%  survive 
the  five-year  period  and  remain  well.  Mobility 
of  the  cancerous  uterus  is  generally  indicative 
of  freedom  from  parametrial  extension  and  there- 
fore, of  operability. 

In  our  series  of  75  cases  of  carcinoma  of  the 
uterus  treated  during  the  period  1924  to  1934, 
approximately  90%  were  of  the  cervix  and  10% 
were  of  the  body  of  the  uterus.  I 2%  were  treat- 
ed surgically,  either  by  complete  abdominal  or 
vaginal  hysterectomy.  88%  were  treated  by  ra- 
diation therapy,  either  radium  alone  or  radium 
combined  with  deep  X-ray  therapy.  The  aver- 
age incidence  of  carcinoma  of  the  cervix  in  our 
group  was  42  years,  and  for  carcinoma  of  the 
body,  56  years.  It  is  our  personal  experience 
that  carcinoma  of  fhe  body  affords  a higher 
percentage  of  cures  than  carcinoma  of  the  cer- 
vix. It  is  our  experience  also  that  all  cases  of 
epithelioma  of  the  cervix  come  late,  and  are,  as 
a rule,  inoperable. 

Our  experiences  are  similar  to  those  Schmidt 
and  Crossen  relative  to  radium  therapy.  We 
give  these  patients  the  maximum  dose  of  three 
to  five  thousand  millicurie  hours,  usually  divided 
into  eight  day  intervals.  During  this  time  deep 


X-ray  therapy  is  given  in  erythema  doses  through 
five  or  six  portals.  Deep  therapy  radiation  can 
safely  be  repeated  at  the  end  of  six  weeks,  and 
again  at  the  end  of  three  months,  according  to 
the  indications.  In  the  advanced  cases,  especial- 
ly those  of  grade  four,  X-ray  therapy  is  given  in 
fractional  doses  over  a much  longer . interval  of 
time  for  palliative  effects  only.  The  higher  the 
grade  of  malignancy,  the  more  radio-sensitive 
we  have  found  them  to  be.  With  this  type  of 
therapy  many  of  the  clinically  hopeless  cases 
are  apparently  cured  and  19%  of  the  cases  treat- 
ed with  radium  alone  survive  the  five-year  pe- 
riod. With  the  modern  advancement  of  deep 
X-ray  therapy,  together  with  the  experience 
gained  at  various  clinics,  combination  therapy 
with  X-ray  and  radium  has  increased  the  cures 
over  a five-year  period  to  22%. 

In  conclusion,  let  me  again  express  to  you  my 
belief  that  "an  ounce  of  prevention  is  worth  a 
pound  of  cure,"  and  if  the  physician  will  give  his 
honest  and  sincere  effort  to  the  early  removal 
and  treatment  of  all  pre-cancerous  lesions,  he 
will  be  of  greatest  service  to  his  patients  and 
his  community. 

DISCUSSION 

C.  S.  Holt,  Fort  Smith:  When  we  hear  papers  read 

on  cancer,  there  are  just  two  things  they  show:  that  is, 
the  cures  and  the  deaths.  I think  that  the  good  surgeons 
are  doing  is  that  we  are  able  to  take  these  cases  and 
make  them  symptom  free  for  from  one  to  eight  years. 
For  that  reason,  we  should  have  always  papers  on  the 
number  of  cases  that  have  been  symptom  free  for  a 
certain  number  of  years. 


WHICH  SIDE  OF  THE  QUESTION 
ARE  YOU  ON? 

Should  mothers  be  given  medical  advice  by  neighbors, 
newspapers,  manufacturers  and  other  meddlers,  gratuit- 
ously, OR 

Should  the  problem  of  infant  feeding  be  kept  where 
it  belongs — in  the  hands  of  the  medical  profession? 

Mead  Johnson  & Company  are  and  always  have  been 
definitely  on  the  side  of  private  medical  practice,  and 
this  is  one  reason  why  we  have  refused  to  advertise 
"complete  foods"  which  "simplify"  infant  feeding.  The 
use  of  cow’s  milk,  water  and  carbohydrate  mixtures  rep- 
resents the  one  system  of  infant  feeding  that  consist- 
ently, for  three  decades,  has  received  universal  pedia- 
tric recognition  because  it  offers  an  adjustable  formula 
for  meeting  the  changing  requirements  of  the  individual 
baby  as  it  progresses.  Of  all  the  carbohydrates  avail- 
able no  carbohydrate  employed  in  this  system  of  infant 
feeding  enjoys  so  rich  and  enduring  a background  of 
authoritative  clinical  experience  as  Dextri-Maltose.  Under 
the  traditional  Mead  policy,  we  re-affirm  the  funda- 
mental principle  that  "Babies  supervised  by  physicians 
are  better  babies."  We  continue  to  be  voluntarily  com- 
mitted to  the  same  side  of  this  important  medical  eco- 
nomic question — as  you. 


194 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  I I 


ENDOCRINE  THERAPY  IN  THE 
CLIMACTERIC* 

G.  REGINALD  SIEGEL,  M.  D. 
Clarksville 


This  paper  is  offered  nof  with  the  idea  of  thor- 
oughly covering  the  subject  but  more  for  the 
purpose  of  causing  the  medical  profession  to  con- 
centrate on  the  pathology  produced  by  endoc- 
rine disorders.  There  are  three  general  types  of 
menopause;  namely,  the  so-called  natural,  the 
artificial,  which  is  brought  on  by  surgical  inter- 
ference or  ray  therapy,  and  the  premature,  which 
occurs  at  an  earlier  date  than  the  natural  meno- 
pause. The  symptoms  in  these  three  forms  are 
much  the  same,  the  principal  difference  being 
the  age  and  abruptness  of  onset.  In  artificial 
menopause  the  symptoms  may  manifest  them- 
selves within  a few  days  following  surgical  or  ray 
interference. 

Symptoms  may  come  abruptly,  there  may  be 
a gradual  change  covering  a period  of  years, 
or  they  may  not  occur  until  the  clinical  mani- 
festations have  terminated.  Vasomotor  symp- 
toms appear  as  distressing  hot  or  cold  flushes, 
perspiration,  vertigo,  faintness,  tachycardia,  gas- 
trointestinal disorders,  numbness  and  tingling  of 
the  hands  and  feet,  various  paraesthesias,  and 
vicarious  bleeding  from  the  nose  or  other  mu- 
cous membrane.  Novak  asserts  that  vasomotor 
conditions  are  present  in  eighty  per  cent  of  the 
patients. 

The  nervous  symptoms  which  are  commonly 
present  include  irritability  from  minor  or  unascer- 
fainable  sources  and  excitability.  There  is  a 
tendency  on  the  part  of  the  patient  to  worry 
over  little  things  which  in  former  years  were  dis- 
regarded, and  most  common  of  all  is  a general 
emotional  instability.  Many  otherwise  undiag- 
nosed symptoms  that  present  no  definite  pathol- 
ogy for  their  cause  can  be  attributed  to  endoc- 
rine troubles. 

All  types  of  psychic  symptoms  are  encounter- 
ed, from  a mild  psychoneurosis  to  an  active  psy- 
chosis. The  most  common  one  encountered  is 
that  of  anxiety.  This  anxiety  differs  from  fear 
in  that  the  subject  dreaded  may  not  even  be 
known  to  the  patient  or  it  may  be  some  trivial 
matter  out  of  all  proportion  to  the  reaction  dis- 
played. Depressions,  phobias,  and  compulsions 

*Read  before  the  Fifty-ninth  Annual  Session  of  the 
Arkansas  Medical  Society,  held  in  Little  Rock  April  16- 
18,  1934. 


are  also  encountered.  The  psychoneurotic  man- 
ifestations are  most  common,  the  psychotic  being 
in  the  minority.  Various  type  shocks  or  condi- 
tions producing  great  sadness  have  brought 
about  a premature  menopause  followed  later  by 
mental  symptoms.  The  decrease  of  sexual  de- 
sire may  occur  gradually,  or  in  some  women,  may 
seem  to  be  abrupt,  although  some  observers  feel 
that  these  women  did  not  have  strong  longings. 
There  are  times,  however,  when  the  inhibitions 
of  sex  are  removed  on  account  of  the  diminished 
fear  of  pregnancy  and  this  is  designated  as  the 
dangerous  age. 

Physical  changes  in  the  later  stages  of  any  of 
the  three  types  of  menopause  include  an  atro- 
phy of  the  subcutaneous  tissue  of  the  external 
genitalia  and  shrinkage  with  a gradual  degenera- 
tion of  the  glandular  elements  of  the  generative 
tract.  The  glandular  substance  of  the  breasts 
disappears  and  at  times  there  is  a marked  in- 
crease of  body  weight.  A quite  frequent  syn- 
drome encountered  is  that  of  arthritis,  which  is 
undoubtedly  due  to  glandular  imbalance. 

It  is  remarkable  to  note  the  return  of  normal 
conditions  in  the  genitalia  and  glandular  ele- 
ments of  the  breasts  after  careful  administra- 
tion of  proper  endocrine  substances.  However, 
the  proper  analysis  must  be  made  so  that  the 
needed  substance  can  be  employed.  Haphazard 
administration  of  glandular  substance  is  unwise 
and  unprofitable. 

Frequently  hypothyroidal  symptoms  are  pres- 
ent, such  as  thinning  out  of  the  hair,  a brittle- 
ness of  the  hair  and  nails,  and  a puffiness  of  the 
face  and  occasionally  of  the  hands  and  feet.  Ex- 
perimentally, the  thyroid  and  ovary  are  closely 
associated  and  this  has  been  emphasized  by  clin- 
ical experience. 

Treatment  is  directy  mainly  toward  ameliora- 
tion of  the  vasomotor,  nervous,  and  psychic 
symptoms.  The  cessation  of  menstruation,  anato- 
mical changes,  and  loss  of  sex  feeling  must  be 
borne  with  philosophy  at  present.  The  real  in- 
volution psychosis  requires  psychiatric  care  in 
addition  to  organotherapy.  In  a much  larger 
proportion  of  cases  than  is  commonly  believed, 
amenorrhea  or  oligomenorrhea  are  the  result  of 
endocrine  disorders  rather  than  of  pelvic  diseases. 

I am  offering  herewith  the  histories  and  treat- 
ments recorded  in  three  cases  of  endocrine  psy- 
choneuroses, and  one  with  merely  the  severe  ir- 
ritability and  other  clinical  changes  that  go  with 
the  ordinary  type  of  case  often  diagnosed  as 
pelvic  inflammation. 


April,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


195 


CASE  NO.  I 

Physical  findings  on  Miss  M.  S..  December  4,  1930: 

Thin,  under-nourished,  stooped  individual,  skin  sallow, 
teeth  good.  Tonsils  small.  Pupils  equal  and  react  to 
light  and  accommodation;  no  convergence  or  divergence; 
no  nystagmus.  Thyroid  small;  no  glandular  enlargements. 
Breasts  atrophied.  Heart:  dullness  with  normal  limits; 
apex  beat  in  fifth  interspace;  rate  regular;  no  murmurs. 
Lungs:  No  voice  changes,  percussion  changes,  or  raleS 
heard.  Abdomen:  Distinct  tenderness  over  the  gall  blad- 
der area  and  over  the  entire  course  of  the  colon;  ab- 
domen is  pot-belly  in  shape,  due  to  a thoracic  spine  cur- 
vature. There  is  tenderness  over  both  kidney  poles; 
spleen  not  palpable;  liver  dullness  not  increased.  Vagi- 
nal: An  atrophic  uterus  with  an  atrophic  vaginal  wall; 
no  tenderness.  Reflexes,  deep  and  superficial,  are  pres- 
ent and  active.  No  clonus  or  abnormal  foot  signs.  Bones 
and  joints  are  normal  except  the  spine,  which  presents 
an  anterior-posterior  and  lateral  painless  curvature  in  the 
mid-thoracic  area.  The  media  and  fundus  are  negative; 
nose  membrane  not  inflamed,  no  deviation  of  septum. 
Ears  negative,  as  are  the  sinuses.  Blood  pressure  100/54; 
pulse  varies  from  70  to  96.  Proctoscopic  examination 
shows  a low  grade  proctitis.  Examination  of  stool  was. 
negative  for  parasites  and  blood.  Urine  1,008,  acid,  2 
plus  albumin,  with  clumped  pus  wells.  Red  cells  4,000,- 
000;  hemoglobin  80%;  white  count  8,000,  normal  differ- 
ential.  Wassermann  and  Kahn  both  negative.  Basal 
metabolic  rate  minus  4.  Ewald  test  meal  showed  an 
absence  of  free  hydrochloric  acid,  total  acitity  22,  noi 
blood  or  lactic  acid. 

X-ray  report  as  follows:  "Patient  is  very  much  curved1 
in  the  thoracic  spine,  and  the  abdomen  is  much  dis- 
tended with  gas.  Chest  is  narrow,  but  shows  no  un- 
usual markings.  Stomach  is  displaced  somewhat  in  the 
abdominal  cavity  and  lies  high  in  position;  is  hypotonic 
in  type.  There  is  some  delay  as  the  barium  enters  the 
cardiac  end,  demonstrated  readily  as  the  stomach  seems 
rotated  by  the  deformity.  However,  the  stomach  fills 
normally;  no  incisura;  no  niche;  peristalsis  vigorous; 
sphincter  is  normal;  there  are  no  tender  points.  Duode- 
nal cap  is  of  medium  size,  in  normal  position;  fills  nor- 
mally in  all  positions  and  is  not  tender.  Ileum  is  low; 
fills  normally;  contains  a six-hour  residue  and  is  not 
tender;  head  of  the  barium  column  is  at  the  cecum  in 
six  hours.  Cecum  fills  normally.  Appendix  is  not  seen. 
Colon  fills  normally,  is  somewhat  enlarged,  with  ptosis 
of  the  transverse  portion,  but  the  waves  of  peristalsis  arei 
deep  and  there  are  areas  of  rather  marked  spasticity. 
There  are  a few  areas  in  the  descending  portion  which 
are  quite  irritable.  Upon  filling  the  stomach  the  initial 
clearing  is  rapid.  The  pylorus  stays  open  for  some  timel 
and  the  barium  flows  quickly  into  the  duodenum  and 
jejunum.  Cholecystography  shows  a gall  bladder  that 
fills  normally,  but  with  considerable  residue  after  the  fatty 
meal,  showing  some  deficiency  in  the  elasticity  of  the 
gall  bladder  wall.  Impression:  This  is  a case  of  spastic, 
colon  with  some  atonicity,  or  at  least  a dilation,  and  a’ 
mild  degree  of  cholecystitis." 

This  case  gave  a history  of  surgical  interference  at  the 
age  of  16,  a double  oophorectomy  following  the  measles. 
Had  been  treated  as  a gall  bladder  patient  on  numerous 
occasions.  Hair  sparse  and  dry,  nails  brittle,  very  nerv- 
ous and  subject  to  a mild  epilepsy. 

Patient  was  placed  on  well  balanced  diet  with  all 
roughage  and  fried  foods  eliminated  and  given  hydro- 
chloric acid,  thyroid  substance,  and  ovarian  substance. 


Her  weight  increased  from  88  lbs.  to  131  lbs.  in  one  year. 
The  spinal  curvature  straightened  and  added  1%  inches 
to  her  height.  Hair  became  silky  and  full  of  life;  skin 
cleared,  losing  the  sallowness;  patient  became  active  and 
grew  stronger;  the  epileptiform  attacks  grew  less  fre- 
quent; and  today,  three  years  later,  the  epileptiform  at- 
tacks apparently  do  not  occur  at  all.  The  glandular 
substance  has  been  continued  at  intervals  to  date. 

CASE  NO.  2 

Mrs.  A.  H.,  aged  27,  married,  mother  of  three  chil- 
dren, normal  in  every  respect.  A railroad  accident  took 
the  life  of  her  youngest  child.  She  became  very  melan- 
choly following  the  loss  and  her  menses  ceased  shortly 
afterwards;  weight  increased  47  lbs.  in  three  months; 
mind  gradually  changed  until  she  acted  the  part  of  an 
idiot,  soiled  her  clothes,  became  listless  and  droopy,  and 
was  diagnosed  as  a dementia  case  and  placed  in  arf 
asylum.  She  remained  in  the  institution  for  seven  months. 

When  this  case  came  under  my  observation  there  had 
been  no  menstruation  for  fifteen  months.  Case  was  ex- 
amined thoroughly,  showing  general  glandular  changed 
of  menopause.  She  was  placed  on  glandular  treatment 
by  oral  and  hypodermic  routes  and  six  vaginal  tampons 
were  used.  Case  menstruated  in  twenty-two  days;  mind 
cleared  in  six  weeks.  Today,  eight  years  later,  she  is 

still  normal  in  both  menses  and  mind  and  she  has  moth- 
ered her  family  in  good  shape. 

CASE  NO.  3 

Miss  F.  S.,  born  December  1898,  a normal  child  in 

every  respect,  with  the  exception  of  occasional  outbreaks 
of  malaria  and  a history  of  a fractured  scapula  during  her 
first  year.  Her  normal  weight  at  the  age  of  21  was  105 
lbs.  She  was  very  stout,  robust,  and  worked  very  hard 
during  her  girlhood  days,  even  to  the  extent  of  doing  a' 

man's  labor  in  the  fields.  She  was  engaged  to  be  mar- 

ried, but  in  September  1921,  her  sweetheart  met  a vio- 
lent death  and  in  the  latter  part  of  the  same  year  she 
entered  the  Benedictine  Order.  She  had  developed  a 
very  melancholy  attitude,  took  practically  no  interest  in 
the  outside  world,  and  was  said  to  be  very,  very  re- 
ligious. 

On  examination  she  was  found  to  be  an  absolute  vir- 
gin with  a small  vaginal  orifice  and  intact  hymen.  The 
subcutaneous  tissue  of  the  external  genitalia  showed  an 
atrophic  condition  with  some  degeneration  of  the  gen- 
erative tract.  Breasts  were  normal  except  the  glandular 
substance  was  absent  allowing  the  skin  to  sag  and  wrin- 
kle; weight  97  lbs.,  blood  pressure  100/60;  pulse  108,  all 
reflexes  highly  exaggerated;  a generalized  eruption  of 
entire  body,  generalized  hairy  growth  on  the  face  as  we 
often  find  in  the  aged  female;  feet  and  hands  swollen; 
an  enlargement  of  the  articular  processes;  both  knees 
slightly  ankylosed,  and  impossible  to  relax  them  without 
pain;  hair  sparse,  had  been  coming  out  in  areas  re- 
sembling alopecia  aerata,  very  dry  and  lifeless  in  appear- 
ance; appetite  very  good;  very  restless  with  short  inter- 
vals of  sleep;  bowels  and  kidneys  act  normal,  but  pa- 
tient unable  to  control  them  until  assistance  to  the  stool 
can  be  given  by  the  attendants. 

Her  mental  condition  was  blank,  except  for  the  recog- 
nition of  certain  people  and  the  ability  to  read  any  writ- 
ten article  placed  before  her.  She  had  a predominant1 
apprehension  of  all  strangers,  having  the  impression  they 
were  about  to  steal  any  object  that  might  be  within  her 
vision.  The  major  psychic  symptom  in  this  case  was  that 
she  thought  people  were  swearing,  cursing,  or  calling  her 


196 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  I 1 


vile  names.  She  did  not  recognize  her  given  name  nor 
her  adopted  name  if  spoken,  but  readily  understood  their 
proper  place  if  written  and  presented  to  her  to  read. 
The  training  of  this  patient  in  the  convent  must  be  taken 
into  consideration,  as  a nun  is  taught  to  exclude  that 
part  of  her  life  prior  to  receiving  her  vows.  She  was 
very  reticent  in  looking  at  pictures  or  discussing  events 
having  to  do  with  her  life  as  a girl.  Her  menstrual  life 
started  at  the  age  of  14  and  continued  until  1929,  at 
which  time  it  ceased  and  had  not  appeared  up  to  the 
time  of  this  examination.  She  was  an  inmate  of  an  Iowa 
mental  and  nervous  hospital  for  eleven  months  in  1931 
and  had  been  an  inmate  of  the  mental  and  nervous  hos- 
pital in  Arkansas  until  December  1932.  She  had  not  re- 
ceived any  medicinal  treatment  at  either  institution.  We 
endeavored  to  handle  this  from  a strictly  endocrine  stand- 
point. 

At  the  end  of  first  week  patient  was  able  to  sit  up 
all  day,  asked  to  be  put  to  bed  at  night,  slept  fairly 
well,  appetite  improved,  bowels  and  kidneys  were  more 
regular  in  action,  the  urine  had  cleared  up,  and  the  feces 
were  beginning  to  become  solid.  At  the  end  of  second 
week  patient  asked  to  be  taken  to  toilet  and  could  con- 
trol bowels  and  kidneys,  swelling  entirely  gone  from  wrists 
and  hands  and  decreased  in  knees  and  ankles.  She  slept 
soundly  at  night  and  it  was  not  necessary  to  fasten  her 
in  bed.  At  the  end  of  third  week  the  rash  had  almost 
entirely  disapeared  from  face  and  body,  wrinkles  were 
fast  disappearing  from  skin,  and  hair  was  oily  with  a lus- 
ter showing  life  and  growth  of  new  hair.  Patient  had  a 
great  deal  of  strength  in  arms.  Edema  had  left  both 
knees  and  feet.  She  showed  fits  of  rather  a mean  tem- 
per when  provoked.  At  the  end  of  fourth  week  patient 
spoke  to  visitors,  calling  those  of  her  former  acquaint- 
ance by  name,  had  dried  the  dishes  on  two  occasions, 
walked  about  fifty  paces  alone,  showed  an  increase  in 
weight,  and  there  was  firmness  and  good  color  in  breasts. 
She  began  to  notice  conversation  which  was  displeasing 
to  her  and  answered  back  in  her  own  defense.  At  the  end 
of  two  months  light  menses  appeared,  of  very  foul  odor 
and  thick.  Patient  carried  on  a very  rational  conversa- 
tion, but  lapsed  into  prayers  at  times.  Helped  with  dish- 
es and  cooking.  All  edema  had  cleared  up  although  the 
arthritis  in  knees  had  not  entirely  disappeared.  At  the 
end  of  eight  months  the  patient  had  regained  normal 
posture  and  the  ankylosis  has  disappeared  from  all 
joints.  She  now  weighs  142  lbs.  and  her  mind  has  re- 
mained ra+ional  in  every  respect  from  October  21st  up  to 
the  present  writing,  December  2nd.  I cannot  definitely 
state  at  this  time  the  outcome  of  the  case,  but  from  all 
appearances,  we  may  expect  a perfectly  normal  being. 

CASE  NO.  4 

Mrs.  G.  W.  M.,  age  27  years,  married  for  ten  years, 
mother  of  two  children  ages  six  and  three  years,  past 
health  good  until  one  year  ago,  not  past  history  of  sick- 
ness except  during  confinement,  started  complaining  of 
pain  in  abdomen  and  air  hunger  and  a continual  pain  in 
head  and  neck.  Weighed  at  time  of  examination  110 
lbs.  Pulse  was  very  rapid,  ranging  from  130  to  146. 
Failed  to  menstruate  in  January,  1933,  and  did  not  show 
any  signs  of  menses  over  a period  of  five  months.  This 
case  was  brought  to  my  attention  because  the  patient 
continually  refused  to  eat,  refused  to  mother  her  chil- 
dren, and  did  not  speak  a word  to  anyone. 

She  was  placed  in  the  hospital  for  observation  and 
forced  feeding  was  used  until  she  regained  sufficient 
strength  to  start  glandular  medication.  Pituitary  sub- 


stance, ovarian  substance,  thyroid  substance,  and  50  per 
cent  glucose  were  used  over  a period  of  six  weeks  by  the 
hypodermic  route  and  the  patient  was  dismissed  from 
the  hospital  when  she  resumed  eating  voluntarily. 

Following  her  dismissal  from  the  hospital  she  was  placed 
on  glandular  substance  by  the  oral  route  and  at  the  pres- 
ent time,  three  months  later,  she  is  perfectly  normal 
mentally,  doing  her  house  work,  mothering  her  children, 
and  serving  in  the  capacity  of  a wife.  She  is  menstruat- 
ing at  28-day  intervals  with  the  menses  lasting  four  to 
five  days. 

There  are  numerous  cases  without  mental  derangements 
that  have  been  treated  for  amenorrhea  in  a milder  man- 
ner and  we  have  found  them  to  respond  very  nicely  in 
all  cases. 

RESULTS  OF  PNEUMOTHORAX. 


Pneumothorax  treatment,  somewhat  slowly  adopted  by 
the  American  medical  profession,  has  now  established  it- 
self as  one  of  the  most  important  weapons  in  the  fight 
against  tuberculosis.  For  some  years  there  has  been  felt 
a need  for  more  precise  data  so  that  pneumothorax  ther- 
apy might  be  fairly  evaluated.  A Committee  on  Arti- 
ficial Pneumothorax  of  the  American  Sanatorium  Associa- 
tion, after  four  years  work,  completed  a survey  of  pneu- 
mothorax in  representative  American  tuberculosis  sanatoria 
covering  the  period  1915-1930.  The  Committee  published 
its  report  recently  in  the  American  Review  of  Tubercu- 
losis. It  is  possible  here  to  offer  only  brief  extracts  of 
the  study  and  the  more  important  conclusions. 

Of  fifty  sanatoria  which  volunteered  to  collaborate, 
twenty-four  furnished  data  on  pneumothorax  sufficiently 
complete  and  suitable  for  study  and  tabulation. 

To  obtain  comparable  data  it  was  necessary  to  define 
a number  of  terms.  Intentional  termination  of  pneumo- 
thorax was  assumed  when  refills  had  been  allowed  to  re- 
lapse. Termination  was  considered  unintentional  when 
obliterative  adhesions  had  encroached  on  the  pleural  cav- 
ity. The  term  pneumothorax  treatment  required  that  there 
must  be  a demonstrable  pleural  sac  and  the  patient  must 
have  received  at  least  100  c.c.  of  air  or  gas  at  regular  in- 
tervals over  a period  of  at  least  three  months. 

Very  important,  not  only  for  this  study  but  for  consid- 
eration of  pneumothorax  in  general,  was  the  effort  of 
the  Committee  to  define  precisely  what  is  meant  by 
effective  collapse.  The  Committee  decided  that  the  fol- 
following  three  conditions  should  be  met,  or  at  least  two 
of  them,  when  the  third  was  doubtful  or  not  stated: 

1.  Disappearance  of  symptoms. 

2.  Disappearance  of  bacillary  sputum. 

3.  Demonstrable  closure  of  cavities,  especially  roent- 
genographically. 

The  incidence  of  pneumothorax  reported  by  the  sana- 
toria varied  from  I per  cent  to  34  per  cent  with  an  aver- 
age of  approximately  10  per  cent. 

Approximately  40  per  cent  of  the  cases  which  received 
pneumothorax  treatment,  showed  considerable  cavitation, 
and  25  per  cent  moderate  cavitation. 

Effective  collapse  was  obtained  or  maintained  in  38  per 
cent  of  the  cases.  In  nearly  two-thirds  of  the  series  it  was 
necessary  to  discontinue  treatment  prematurely,  most  fre- 
quently because  of  the  development  of  pleural  compli- 
cations. Two  factors,  small  proportion  of  cases  suscepti- 
ble to  effective  collapse,  and  forced  premature  discon- 
tinuance of  collapse,  appear  to  limit  most  seriously  the 
success  of  pneumothorax  therapy. 


April,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


197 


THE  TYPHOID  BACILLUS  IN  MILK  AND 
WATER  SUPPLIES 

W.  B.  GRAYSON,  M.  D. 

State  Health  Officer,  and 
H.  V.  STEWART,  B.  S. 

Director  Hygienic  Laboratory 
Little  Rock 


The  fact  that  the  typhoid  bacillus  is  trans- 
mitted by  both  milk  and  water  supplies  is  so  well 
established  that  nothing  further  need  be  said  on 
that  point,  but  how  to  establish  its  presence  in  a 
particular  milk  or  water  supply  is  quite  another 
matter.  There  seems  to  be  an  impression  in  the 
mind  of  the  laity  and  even  of  some  members  of 
the  profession  that  there  is  a comparatively  sim- 
ple procedure  by  means  of  which  the  laboratory 
is  able  to  establish  the  presence  of  the  typhoid 
bacillus  in  a small  sample  of  milk  or  water.  When 
one  considers  the  fact  that  one  or  two  typhoid 
bacilli  per  gallon  of  milk  or  water  are  sufficient 
to  start  a serious  epidemic  and  how  almost  im- 
possible it  is  for  the  laboratory  to  search  out, 
find  and  identify  the  one  or  two  typhoid  bacilli 
in  a gallon  of  milk  that  may  contain  thirty-eight 
million  bacteria  per  gallon  and  still  be  the  best 
quality  Grade  A milk;  or  to  find  the  one  or  two 
typhoid  bacilli  in  a gallon  of  water  that  may  con- 
tain as  many  as  375,000  bacteria  per  gallon  and 
still  be  classed  as  acceptable  and  safe  drinking 
water,  one  realizes  that  the  task  is  not  so  simple 
after  all  and  that  even  the  best  of  laboratories 
has  its  limitations. 

After  considering  the  difficulty  of  isolating  the 
typhoid  bacillus  from  suspected  milk  or  water 
supplies,  we  are  forced  to  the  conclusion  that 
some  other  means  than  the  direct  examination 
of  the  sample  must  be  used  in  obtaining  our  in- 
formation. So  we  gather  together  the  known 
facts  concerning  the  typhoid  bacillus  and  plan 
our  work  accordingly. 

In  the  first  place,  we  know  that  the  typhoid 
bacillus  is  not  a normal  inhabitant  of  milk  or  water 
and,  therefore,  it  must  gain  access  to  the  milk 
or  water  from  some  source  where  it  is  normally 
able  to  grow  and  multiply.  The  most  logical 
source  to  consider  in  meeting  this  requirement  is 
the  human  intestine  where  we  know  that  the  ty- 
phoid bacillus  is  able  to  grow  and  even  multiply 
to  the  extent  that  the  host  of  this  unwelcome 
bacillus  becomes  ill  and  develops  what  is  known 
as  typhoid  fever.  We  also  know  that  certain 
individuals  harbor  the  typhoid  bacillus  without 
showing  any  symptoms  of  the  disease,  and  that 


other  individuals  continue  to  harbor  the  bacillus 
for  varying  periods  of  time  after  they  have  re- 
covered from  an  attack  of  typhoid  fever.  These 
two  classes  of  individuals  are  known  as  typhoid 
carriers.  So  it  seems  logical  then,  when  we  are 
endeavoring  to  determine  whether  or  not  a milk 
or  water  supply  is  safe  for  use,  to  search  out  the 
source  or  sources  from  which  the  typhoid  bacillus 
may  have  gained  entrance  to  the  milk  or  water 
supply. 

In  the  case  of  milk  supplies  we  first  determine 
whether  or  not  there  is  an  active  case  of  typhoid 
fever  among  those  who  handle  the  milk;  second, 
whether  a person  recently  recovered  from  ty- 
phoid fever  is  in  any  way  associated  with  the 
handling  of  milk;  third,  whether  there  are  any 
typhoid  carriers  associated  in  any  way  with  the 
handling  of  milk;  and,  fourth,  but  not  least  in 
value,  we  examine  critically  the  sanitary  surround- 
ings of  the  dairy  and  the  manner  in  which  the 
milk  is  handled  to  determine  whether  the  ty- 
phoid bacillus  could  gain  entrance  to  the  milk 
if  a carrier  were  assisting  in  its  preparation  for 
the  market. 

In  the  case  of  water  supplies  we  must  make  a 
careful  sanitary  survey  of  the  well  and  its  sur- 
roundings to  determine  the  possibility  of  human 
excrement  gaining  entrance  to  the  water  supply. 
This  will  involve  first  the  location  of  the  well  to 
determine  whether  sewage  laden  water  from  a 
privy  or  broken  sewer  line  may  gain  entrance  to 
the  well  by  seepage  through  the  soil;  second, 
whether  the  well  is  properly  tiled  and  fitted  with 
a tight  cover  so  that  surface  contamination  can- 
not gain  entrance  either  by  waste  water  or  dur- 
ing periods  of  rainy  weather;  and,  third  whether 
or  not  the  well  is  provided  with  a pump  so  that 
the  water  from  the  well  may  be  brought  to  the 
surface  without  introducing  contaminating  ma- 
terial from  any  source. 

Since  it  is  impractical  to  make  a bacteriologi- 
cal examination  of  the  water  for  the  purpose  of 
finding  the  typhoid  bacillus,  we  must  use  some 
other  factor  by  which  to  judge  the  fitness  of  the 
water  for  drinking  purposes.  The  factor  we  have 
chosen  for  this  purpose  is  the  presence  or  ab- 
sence of  the  bacillus  coli  communis  (commonly 
known  as  B.  coli  but  properly  referred  to  as  Es- 
cherichia coli),  for  we  know  that  it  is  not  a normal 
inhabitant  of  water  but  is  a normal  inhabitant 
of  the  intestinal  tract  of  both  man  and  beast. 
Therefore,  if  we  find  it  present  in  water  we  know 
that  that  water  is  being  contaminated  with  the 
fecal  discharge  from  either  man  or  beast  and 


198 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  I i 


it  is  possible  for  the  typhoid  bacillus  also  to  be 
present  and  thus  render  the  water  potentially 
dangerous  and  unfit  for  drinking  purposes. 

The  significance  of  B.  coli  in  milk  is  not  to  be 
interpreted  in  the  same  manner  as  we  interpret 
its  presence  in  water,  for  we  know  that  B.  coli, 
being  a normal  inhabitant  of  the  intestinal  tract 
of  cows  and  other  farm  animals,  will  naturally  be 
found  in  great  numbers  in  the  soil  and  dust 
around  barnyards  and  dairy  barns  and  thus  will 
be  present  on  the  hair  and  udders  of  the  cows. 
Therefore,  when  B.  coli  is  found  in  milk  its  pres- 
ence indicates  first  that  the  milking  was  done  in 
a dusty,  dirty  barn,  and  from  cows  that  had  not 
been  properly  cleaned  before  being  milked;  or 
second,  that  the  milk  buckets  and  other  utensils 
were  not  properly  cleaned  before  being  used. 
These  facts  being  true,  it  is  easily  seen  that  a 
careful  inspection  of  the  dairy  and  the  methods 
of  procedure  used  in  that  dairy  will  divulge  far 
more  information  than  any  laboratory  test  that 
could  be  made. 

In  our  endeavor  to  establish  the  safety  of  a 
water  supply  we  must  again  consider  the  value 
of  a careful  inspection  of  the  well  and  its  sur- 
roundings and  realize  the  limitations  of  the  labor- 
atory examination.  As  has  been  shown,  B.  coli 
may  have  its  origin  in  the  intestinal  tract  of  man 
where  it  may  be  associated  with  the  typhoid 
bacillus  and  thus  if  found  in  a water  supply  would 
render  that  water  unsafe  for  drinking  purposes. 
Unfortunately  the  laboratory  examination  is  un- 
able to  differentiate  between  the  B.  coli  of  hu- 
man origin  and  those  originating  in  the  intes- 
tines of  animals.  Therefore,  unless  the  well  is 
protected  from  all  visible  evidence  of  sewage 
contamination,  is  tightly  covered,  and  provided 
with  a pump  so  that  an  uncontaminated  sample 
of  the  water  may  be  collected,  it  is  useless  to 
expect  the  laboratory  to  say  whether  the  con- 
tamination found  is  or  is  not  dangerous  in  char- 
acter. 

Open  wells  and  those  wells  provided  with  a 
rope  and  bucket  are  invariably  subject  to  con- 
tamination by  dust  and  dirt  blown  or  washed  into 
the  well  and  from  dirty  hands  that  handle  the 
rope  and  bucket  and  thus  contaminate  the  water. 
A laboratory  examination  is  useless  to  determine 
its  safety  for  in  this  case  B.  coli  may  be  present 
in  the  water  in  relatively  large  numbers  but  still 
the  water  may  be  safe  for  drinking  purposes 
provided  the  possibility  of  sewage  contamina- 
tion can  be  excluded. 


Thus  it  is  clearly  apparent  that  it  is  useless  and 
a waste  of  time  and  money  to  send  samples  of 
water  to  the  laboratory  for  examination  from 
open  wells  or  wells  that  are  provided  with  rope 
and  bucket,  and  other  such  unprotected  sources, 
for  we  know  from  our  sanitary  survey  alone  that 
such  supplies  are  contaminated  and,  therefore, 
potentially  dangerous. 


RESOLUTION 


Whereas,  God  in  his  'infinite  wisdom  has  suddenly 
snatched  from  our  midst  our  friend  and  colleague,  Dr. 
V.  L.  Pascoe,  Newark,  Arkansas,  and 

Whereas,  Dr.  Pascoe  was  endeared  to  us  by  his  gen- 
ial personality,  his  kindliness,  ' and  charitable  nature.  Not 
only  did  his  traits  of  character  appeal  to  us  and  make 
us  desire  to  emulate  them,  but  we  shall  ever  remem- 
ber his  medical  skill  and  his  ability  to  cure  the  sick.  He 
was  born  and  reared  in  this  county  and  gave  his  entire 
life  to  the  practice  of  medicine  here.  He  was  ethical 
in  his  dealings  with  other  physicians  and  was  a real 
friend  to  the  young  doctors.  He  was  not  only  a lead- 
ing man  in  his  profession  but  one  of  our  best  citizens. 
His  friends  were  numbered  by  all  who  knew  him. 

Therefore,  Be  it  resolved  that  the  Independence  Coun- 
ty Medical  Society  in  session  assembled  express  our  ap- 
preciation for  the  noble  work  that  Dr.  Pascoe  has  done 
among  us;  that  we  as  a society  feel  a sense  of  per- 
sonal loss  in  his  death  and  shall  ever  cherish  his  mem- 
ory; and  that  we  recommend  to  the  members  of  the 
society  that  they  follow  the  high  ethical  standards  which 
Dr.  Pascoe  unfailingly  followed;  and 

Be  it  further  resolved  that  we  express  our  sympathy 
to  Mrs.  Pascoe  for  her  irreparable  loss;  and  that  a copy 
of  this  resolution  be  sent  to  Mrs.  Pascoe;  that  a copy 
be  spread  on  the  minutes  of  the  society  and  that  a copy 
be  sent  to  the  press. 

DR.  O.  L.  BONE,  Newark,  Ark. 

DR.  L.  T.  EVANS,  Batesville,  Ark., 

DR.  F.  A.  GRAY,  Batesville,  Ark., 

Committee. 


COMING  MEDICAL  MEETINGS 


Third  Councilor  District  Medical  Society,  De- 
Vall's  Bluff,  April  5th. 

Second  Councilor  District  Medical  Society, 
Batesville,  April  8th. 

ARKANSAS  MEDICAL  SOCIETY,  FORT 
SMITH,  APRIL  I5-I7TH. 

Ninth  Councilor  District  Medical  Society, 
Mountain  Home,  June  4th. 

American  Medical  Association,  Atlantic  City, 
June  1 0- 1 4th. 


April,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


199 


THE  JOURNAL 

OF  THE 

ARKANSAS  MEDICAL  SOCIETY 


Owned  by  the  Arkansas  Medical  Society  and  Published 
under  direction  of  the  Council 


DR.  W.  R.  BROOKSHER,  Editor 
610  First  National  Bank  Bldg.,  Fort  Smith,  Arkansas 


The  advertising  policy  of  this  Journal  is  governed  by  the  rules 
of  the  Council  on  Pharmacy  and  Chemistry  of  the  American 
Medical  Association. 

All  communications  to  this  Journal  must  be  made  to  it  exclu- 


sively. Communications  and  items  of  general  interest  to  the  pro- 
fession are  invited  from  all  over  the  State.  Notice  of  deaths, 
'emovals  from  the  State,  changes  of  location,  etc.,  are  requested. 


OFFICERS  OF  THE  ARKANSAS  MEDICAL  SOCIETY 

F.  O.  MAHONY,  President El  Dorado 

M.  E.  McCASKILL,  President-Elect Little  Rock 

A.  M.  ELTON,  First  Vice-President Newport 

S.  C.  FULMER,  Second  Vice-President Little  Rock 

F.  D.  SMITH,  Third  Vice-President B lythevi I le 

R.  J.  CALCOTE,  Treasurer  Little  Rock 

W.  R.  BROOKSHER,  Secretary Fort  Smith 


COUNCILORS 

First  District — W.  M.  MAJORS  Paragould 

Second  District — S.  J.  ALLBRIGHT  . Searcy 

Third  District — M.  C.  JOHN  Stuttgart- 

Fourth  District — C.  W.  DIXON  Gould 

Fifth  District — L.  L.  PURIFOY  El  Dorado 

Sixth  District — DON  SMITH Hope 

Seventh  District — GEO.  B.  FLETCHER  Hot  Springs 

Eighth  District — S.  B.  HINKLE Little  Rock 

Ninth  District — D.  L.  OWENS Harrison 

Tenth  District— S.  J.  WOLFERMANN Fort  Smith 


COMMITTEES 

(Appointments  expire  in  the  year  indicated.) 

Scientific  Work — L.  L.  Purifoy,  Chairman,  El  Dorado  (1935);  R. 
B.  Robins,  Camden  (1936);  W.  R.  Brooksher,  Fort  Smith  (1937). 

Medical  Legislation — Val  Parmley,  Chairman,  Little  Rock 

(1937);  M.  L.  Norwood,  Lockesburg  (1937);  O.  L.  Williamson, 
Marianna  (1937);  H.  T.  Smith,  McGehee  (1936);  R.  L.  Smith, 
Russellville  (1936);  A.  S.  Buchanan,  Prescott  (1935);  H.  A.  Dish  - 
ongh,  Little  Rocks  (1935). 

Health  and  Public  Instruction — W.  B.  Grayson,  Chairman,  Little 
Rock  (1937);  S.  W.  Douglas,  Eudora  (1937);  B.  M.  Stevenson, 
Crawfordsville  (1937);  H.  K.  Carrington,  Magnolia  (1936);  H.  A. 
Stroud,  Jonesboro  (1936);  J.  H.  Fowler,  Harrison  (1935);  E.  J. 
Munn,  El  Dorado  (1935). 

Medical  Education  and  Hospitals — Joe  F.  Shuffield,  Chairman, 
-ittle  Rock  (1937);  David  Levine,  El  Dorado  (1936);  J.  B.  Futrell, 
Rector  (1935). 

Public  Relations — D.  A.  Rhinehart,  Chairman,  Little  Rock  (1937); 
E.  E.  Barlow,  Dermott  (1936);  M.  E.  McCaskill,  Little  Rock  (1935). 

Medical  Economics — I.  F.  Jones,  Chairman,  Fort  Smith  (1937); 
R.  B.  Robins,  Camden  (1937);  J.  E.  Neighbors,  Stuttgart  (1936); 
D.  E.  White,  El  Dorado  (1936);  Roy  Millard,  Dardanelle  (1935); 
A.  C.  Shipp,  Little  Rock  (1935);  R.  M.  Sloan,  Jonesboro  (1935). 

Scientific  Exhibit — F.  H.  Krock,  Chairman,  Fort  Smith  (1935); 
H.  King  Wade,  Hot  Springs  National  Park  (1936);  W.  E.  Gray, 
Hot  Springs  National  Park  (1937). 

Arrangements— (Host  Society  1935  meeting)— D.  W.  Goldstein, 
Chairman,  C.  S.  Holt,  J.  A.  Foltz,  H.  Moulton,  M.  E.  Foster, 
W.  G.  Eberle,  I.  F.  Jones. 

Necrology — W.  H.  Mock,  Chairman,  Prairie  Grove  (1935)'  J. 
M.  Lemons,  Pine  Bluff  (1936);  H.  Moulton,  Fort  Smith  (1937)'. 

Auxiliary— L.  J.  Kosminsky,  Chairman,  Texarkana  (1935);  W.  T. 
Wootton,  Hot  Springs  National  Park  (1936);  C.  S.  Holt  Fort 
Smith  (1937). 

Cancer  Control — D.  W.  Goldstein,  Chairman,  Fort  Smith  (1937); 
R.  L.  Saxon,  Little  Rock  (1936);  L.  A.  Purifoy,  El  Dorado  (1935).* 


* Deceased. 


We  are  not  stand  patters.  We  are  willing  to  try  any 
experiment  which  looks  as  though  it  might  be  the  answer 
to  the  modern  problem  of  care  of  the  sick  poor.  But  it 
must  be  a controlled  experiment.  And  we  must  be  as- 
sured that,  so  far  as  we  can  control  it,  standards  of  prac- 
tice will  not  be  lowered. — Morris  Fishbein,  M.  D.,  in  Min- 
nesota Medicine. 


EDITORIAL 


ANNUAL  SESSION. 


The  Sixtieth  Annual  Session  of  the  Arkansas 
Medical  Society  will  convene  in  Fort  Smith  on 
April  15,  16  and  17th.  This  issue  carries  the 
preliminary  program  and  announcements.  Par- 
ticular attention  is  directed  to  the  scientific 
program  with  its  guest  speakers,  a well-chosen 
list  of  physicians  qualified  to  address  the  So- 
ciety on  diversified  topics.  The  Society  is  hon- 
ored in  that  Dr.  Walter  L.  Bierring,  President  of 
the  American  Medical  Association,  selected  Ark- 
ansas as  one  of  the  states  whose  invitation  he 
would  accept  at  a time  when  there  is  an  unusu- 
al demand  for  his  services  by  state  societies.  His 
message  to  the  general  session  will  concern  it- 
self with  the  activities  of  the  parent  associa- 
tion. For  the  evening  public  session,  his  subject 
will  be,  "The  Doctor  and  Plans  for  Economic  Se- 
curity." The  Society  is  fortunate  in  having  a 
speaker  of  such  prominence  to  present  the  view- 
point of  organized  medicine  on  proposed  social- 
istic measures  for  medical  care.  That  Arkansas 
physicians  are  continuing  their  studies  and  re- 
search is  manifest  from  their  number  and  the 
character  of  their  papers  on  the  scientific  pro- 
gram. 

Several  important  matters  await  the  action  of 
the  House  of  Delegates.  The  need  for  a broad- 
ening of  the  activities  of  the  Society,  more 
pressing  now  because  of  efforts  at  the  socializa- 
tion and  regimentation  of  the  medical  profession, 
cannot  be  met  on  the  present  curtailed  income. 
If  the  Society  is  to  render  the  proper  service  and 
to  make  membership  indispensable  to  the  physi- 
cians of  Arkansas,  there  must  be  added  income 
for  the  inauguration  of  new  services,  as  well  as 
for  the  extension  of  existing  functions.  There  is 
a constant  demand  that  the  state  society  under- 
take new  projects,  that  its  influence  be  extended 
to  other  fields  and  that  it  aggressively  fight  to 
eradicate  situations  harmful  alike  to  the  public 
welfare  and  to  the  practice  of  medicine  which 
now  exist  in  the  state.  Too,  there  is  need  for  a 
more  efficient  organization  of  county  units,  for  a 
more  aggressive  plan  of  attack  when  the  rights 
of  members  are  threatened  by  legislative  action, 
or  in  other  manner.  The  Society  must  actively 
plan  and  support  publicity  favorable  to  organ- 
ized medicine  as  opposed  to  the  panaceas  so 
widely  offered  by  social  workers  and  philanthrop- 
ists. All  these  and  other  problems  require  the 
thoughtful  attention  of  the  delegates. 


200 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  I I 


The  Sebastian  County  Medical  Society  as 
hosts  assures  every  member  a good  time,  having 
arranged  for  social  functions  sufficient  to  pro- 
duce relaxation  from  all  cares  of  the  every-day 
practice  of  medicine  as  well  as  from  the  routine 
of  the  convention  work-day.  The  social  features 
of  the  1930  meeting  were  favorably  commented 
upon  by  all  members  in  attendance.  The  host 
society  assures  The  Journal  that  these  features 
of  the  1930  session  are  being  used  as  the  start 
for  the  1935  festivities  and  that  the  additions 
will  be  pleasing  indeed. 


IN  MEMORIAM. 


The  publication  in  this  issue  of  the  names  of 
those  members  who  have  answered  their  Last 
Call  prompts  the  thought  that  too  often  this  op- 
portunity to  suitably  record  the  passing  of  ones 
near  and  dear  to  many  of  us  is  not  afforded  The 
Journal.  With  rare  exceptions  the  information 
contained  in  the  obituary  notice  is  obtained 
from  sources  other  than  the  colleagues  of  the 
deceased  physician.  Often  a long  time  elapses 
before  the  editorial  force  receives  any  notice  of 
the  fact,  press  notice  of  the  physician's  death 
not  being  observed  by  the  editor. 

Usually  the  member's  county  society  appoints 
a committee  to  draft  suitable  resolutions  of  his 
activities  and  character.  This  should  be  the  in- 
variable custom.  These  resolutions  should  be 
submitted  to  The  Journal  in  form  for  publication 
that  they  may  stand  as  a permanent  record. 

The  Journal  makes  the  plea  that  county  so- 
ciety secretaries  and  friends  of  our  departed 
colleagues  take  steps  to  see  that  The  Journal  is 
promptly  advised  on  these  occasions,  and  that 
suitable  memorial  resolutions  are  promptly  pre- 
pared. This  much  is  the  privilege  of  those  who 
mourn. 


LEGISLATIVE  COMMITTEE. 


"Energy  and  Persistence  conquer  all." — Franklin. 

To  the  Legislative  Committee  which  worked 
long  hours  and  most  diligently  during  the  Fiftieth 
General  Assembly  of  the  State  of  Arkansas,  the 
Society  offers  its  most  sincere  appreciation.  The 
program  of  medical  legislation  as  proposed  by 
this  committee  was  carried  out  in  every  particu- 
lar. Certain  harmful  measures,  and  their  num- 
ber was  not  few,  were  unsuccessful  due  to  the  un- 
tiring efforts  of  the  members  of  the  committee. 
Participation  on  this  committee  requires  far 


more  than  routine  adherence  to  the  ideals  of 
organized  medicine;  it  requires  unselfish  sacri- 
fice of  personal  interests,  the  denial  of  personal 
gain  in  practice  lost,  in  order  that  the  interests 
of  the  Society  may  be  ever  protected.  The  So- 
ciety may  well  be  proud  of  these  members  and 
their  accomplishments. 

<g, 

EDITORIAL  COMMENT 


Members  will  be  interested  to  know  of  the  ac- 
complishments of  the  Legislative  Committee  dur- 
ing the  recent  session  of  the  legislature.  Four 
laws  were  enacted  which  are  of  definite  benefit 
to  the  physicians  of  Arkansas:  (I)  Fixing  a three- 
year  statute  of  limitations  on  malpractice  ac- 
tions, the  time  to  run  from  the  time  of  the  com- 
mission of  the  alleged  malpractice;  (2)  Providing 
that  each  of  the  healing  art  boards  shall  file  in 
the  office  of  the  secretary  of  state  the  names  of 
all  licentiates  to  whom  licenses  have  been  issued 
during  the  past  twenty  years,  and  that  the  bu- 
reau of  vital  statistics  shall  further  certify  to  the 
secretary  of  state  the  names  of  all  deceased  li- 
centiates; (3)  to  restrict  the  sale  of  barbituric 
acid  preparations  except  on  the  prescription  of  a 
physician  or  dentist;  and  (4)  providing  for  the 
recognition,  in  their  discretion,  by  the  State 
Medical  Board  of  the  Arkansas  Medical  Society 
of  certificates  issued  by  the  National  Board  of 
Medical  Examiners.  A number  of  bills,  harmful 
to  the  interests  of  the  medical  profession,  were 
either  defeated  or  not  introduced  because  of  the 
efforts  of  the  committee  and  our  legal  counsel, 
Hon.  Peter  A.  Deisch.  Among  these  were  lib- 
eralization of  the  privileges  of  osteopaths,  the 
workmen's  compensation  bill,  the  so-called  "bar- 
ber" bill  and  the  resolution  calling  for  an  investi- 
gation of  the  faculty  of  the  medical  school. 


OBITUARY 

JAMES  WILEY  SLAUGHTER,  aged  49  years, 
died  suddenly  at  his  home  in  Kilgore,  Texas, 
March  17th,  1935.  A practicing  phyician  of 
Norphlet  for  the  past  twelve  years,  Dr.  Slaughter 
had  only  moved  to  his  new  location  in  February. 
He  was  a graduate  of  the  University  of  Arkansas 
School  of  Medicine  in  1912  and  was  a member 
of  the  Union  County  Medical  Society  and  a 
Fellow  of  the  American  Medical  Association.  Sur- 
viving relatives  are  his  wife  and  one  daughter. 


April,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


201 


Preliminary  Program  (A  Announcements 

OF  THE 

SIXTIETH  ANNUAL  SESSION  OF  THE 

ARKANSAS  MEDICAL  SOCIETY 

FORT  SMITH 
APRIL  15,  16,  17,  1935 

HEADQUARTERS— GOLDMAN  HOTEL 


OFFICERS 

PRESIDENT— F.  O.  Mahony,  El  Dorado. 
PRESIDENT-ELECT— M.  E.  McCaskill,  Little  Rock. 

FIRST  VICE-PRESIDENT— A.  M.  Elton,  Newport. 

SECOND  VICE-PRESIDENT— S.  C.  Fulmer,  Little  Rock. 
THIRD  VICE-PRESIDENT— F.  D.  Smith,  Blytheville. 
TREASURER — R.  J.  Calcote,  Little  Rock. 

SECRETARY — W.  R.  Brooksher,  Fort  Smith. 

COUNCILORS  AND  COUNCILOR 
DISTRICTS 

FIRST  DISTRICT — Clay,  Crittenden,  Craighead,  Greene, 
Lawrence,  Mississippi,  Poinsett  and  Randolph  counties. 
Councilor,  W.  M.  Majors,  Paragould.  Term  of  office 
expires  1935. 

SECOND  DISTRICT — Cleburne,  Fulton,  Independence, 
Izard,  Jackson,  Sharp  and  White  counties.  Councilor, 
S.  J.  Allbright,  Searcy.  Term  of  office  expires  1936. 

THIRD  DISTRICT — Arkansas,  Cross,  Lee,  Lonoke,  Mon- 
roe, Phillips,  Prairie,  St.  Francis  and  Woodruff  coun- 
ties. Councilor,  M.  C.  John,  Stuttgart.  Term  of  office 
expires  1935. 

FOURTH  DISTRICT— Ashley,  Bradley,  Chicot,  Cleveland, 
Drew,  Desha,  Jefferson  and  Lincoln  counties.  Councilor, 

C.  W.  Dixon,  Gould.  Term  of  office  expires  1936. 

FIFTH  DISTRICT — Calhoun,  Columbia,  Dallas,  LaFayette, 
Ouachita  and  Union  Counties.  Councilor,  L.  L.  Puri- 
foy,  El  Dorado.  Term  of  office  expires  1935. 

SIXTH  DISTRICT — Hempstead,  Howard,  Little  River,  Mil- 
ler, Nevada,  Pike,  Polk  and  Sevier  counties.  Councilor, 
Don  Smith,  Hope.  Term  of  office  expires  1936. 

SEVENTH  DISTRICT— Clark,  Garland,  Grant,  Hot  Spring, 
Montgomery,  Saline  and  Scott  counties.  Councilor, 
Geo.  B.  Fletcher,  Hot  Springs  National  Park.  Term  of 
office  expires  1935. 

EIGHTH  DISTRICT— Conway,  Faulkner,  Johnson,  Perry, 
Pope,  Pulaski  and  Yell  counties.  Councilor,  S.  B.  Hinkle, 
Little  Rock.  Term  of  office  expires  1936. 

NINTH  DISTRICT — Baxter,  Boone,  Carroll,  Marion,  New- 
ton, Searcy,  Stone  and  Van  Buren  counties.  Councilor, 

D.  L.  Owens,  Harrison.  Term  of  office  expires  1935. 
TENTH  DISTRICT — Benton,  Crawford,  Franklin,  Logan, 

Madison,  Sebastian  and  Washington  counties.  Coun- 
cilor, S.  J.  Wolfermann,  Fort  Smith.  Term  of  office 
expires  1936. 


DELEGATE  TO  THE  AMERICAN  MEDICAL  ASSOCIA- 
TION— L.  J.  Kosminsky,  Texarkana,  (1935);  W.  R. 
Brooksher,  Fort  Smith,  (1934). 

COMMITTEES 

(Appointments  expire  in  the  year  indicated) 

SCIENTIFIC  WORK— L.  L.  Purifoy,  Chairman,  El  Dorado 
(1935);  R.  B.  Robins,  Camden  (1936);  W.  R.  Brook- 
sher, Fort  Smith  (1937). 

MEDICAL  LEGISLATION — Val  Parmley,  Chairman,  Little 
Rock  (1937);  M.  L.  Norwood,  Lockesburg  (1937);  O. 
L.  Williamson,  Marianna  (1937);  H.  T.  Smith,  McGehee 
( 1936) ; R.  L.  Smith,  Russellville  ( 1936)  ; A.  S.  Buchanan, 
Prescott  (1935);  H.  A.  Dishongh,  Little  Rock  (1935). 

HEALTH  AND  PUBLIC  INSTRUCTION— W.  B.  Grayson, 
Chairman,  Little  Rock  (1937);  S.  W.  Douglas,  Eudora 
(1937);  B.  M.  Stevenson,  Crawfordsville  (1937);  H.  K. 
Carrington,  Magnolia  (1936);  H.  A.  Stroud,  Jones- 
boro (1936);  J.  H.  Fowler,  Harrison  (1935);  E.  J. 
Munn,  El  Dorado  (1935). 

MEDICAL  EDUCATION  AND  HOSPITALS— Joe  F.  Shuf- 
field,  Chairman,  Little  Rock  (1937);  David  Levine,  El 
Dorado  (1936);  J.  B.  Futrell,  Rector  (1935). 

PUBLIC  RELATIONS — D.  A.  Rhinehart,  Chairman,  Little 
Rock  (1937);  E.  E.  Barlow,  Dermott  (1936);  M.  E.  Mc- 
Caskill, Little  Rock  (1935). 

MEDICAL  ECONOMICS — I.  F.  Jones,  Chairman,  Fort 
Smith  (1937);  R.  B.  Robins,  Camden  (1937);  J.  E. 
Neighbors,  Stuttgart  (1936);  D.  E.  White,  El  Dorado 
(1936);  Roy  Millard,  Dardanelle  (1935);  A.  C.  Shipp, 
Little  Rock  (1935);  R.  M.  Sloan,  Jonesboro  (1935). 

SCIENTIFIC  EXHIBIT— F.  H.  Krock,  Chairman,  Fort  Smith 
(1935);  H.  King  Wade,  Hot  Springs  National  Park 
( 1936) ; W.  E.  Gray,  Hot  Springs  National  Park  ( 1937). 

ARRANGEMENTS — (Host  Society  1935  meeting) — D.  W. 
Goldstein,  Chairman;  C.  S.  Holt,  J.  A.  Foltz,  H.  Moul- 
ton, M.  E.  Foster,  W.  G.  Elberle,  I.  F.  Jones. 

NECROLOGY — W.  H.  Mock,  Chairman,  Prairie  Grove 
(1935);  J.  M.  Lemons,  Pine  Bluff  (1936);  H.  Moulton, 
Fort  Smith  ( 1937). 

AUXILIARY — L.  J.  Kosminsky,  Chairman,  Texarkana 
(1935);  W.  T.  Wootton,  Hot  Springs  National  Park 
(1936);  C.  S.  Holt,  Fort  Smith  (1937). 

CANCER  CONTROL — D.  W.  Goldstein,  Chairman,  Fort 
Smith  (1937);  R.  L.  Saxon,  Little  Rock  (1936);  L.  A. 
Purifoy,  El  Dorado  (1935).* 

* Deceased. 


202 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  I I 


ANNOUNCEMENTS 

REGISTRATION 

The  registration  desk  will  be  located  in  the  Goldman 
Hotel  lobby  and  will  be  open  from  8:00  a.  m.  to  5:00 
p.  m. 

The  delegates  are  requested  to  register  as  early  as 
possible,  so  that  the  House  of  Delegates  may  proceed 
with  its  business,  beginning  promptly  at  9:30  a.  m.,  April 
15th.  Members  are  also  requested  to  register  and  re- 
ceive the  official  badge  and  program. 

All  meetings  except  the  open  session  on  Monday 
evening,  April  15th,  will  be  held  in  the  Goldman  Hotel. 
The  open  session  will  be  held  in  the  Senior  High  School 
Auditorium,  North  23rd  and  "B"  streets. 

MEETING  OF  THE  COUNCIL 

The  Council  of  the  Arkansas  Medical  Society,  includ- 
ing the  Past-presidents,  will  meet  at  noon  each  day  with 
luncheon  in  the  private  dining  room,  Goldman  Hotel, 
immediately  following  the  adjournment  of  the  morning 
sessions. 

GOLF 

Members  will  be  privileged  to  play  at  Rolling  Knolls, 
Hardscrabble,  or  U.  C.  T.  Clubs.  Greens  fees  will  be 
waived  on  presentation  of  the  official  badge.  The 
Dewell  Gann,  Jr.,  cup  will  be  contested  for  at  Hard- 
scrabble Country  Club.  Members  desiring  to  play  golf 
are  requested  to  so  indicate  when  registering.  Further 
announcements  will  be  made  during  the  meeting. 

CIVIC  CLUBS 

Meeting  in  Goldman  Hotel  at  12:10  p.  m. 
Tuesday,  April  16th — LION'S  CLUB. 

Wednesday,  April  17th — ROTARY  CLUB. 


PROGRAM 

HOUSE  OF  DELEGATES 

First  Meeting,  Goldman  Hotel,  April  15,  9:30  a.  m. 
Meeting  called  to  Order  by  F.  O.  Mahony,  President. 
Calling  Roll  of  Delegates. 

Appointment  of  Credentials  Committee  and  their  report. 
Introduction  of  Fraternal  Delegates. 

Adoption  of  Minutes  of  the  Fifty-Ninth  Annual  Session 
as  published  in  the  June,  1934,  issue  of  the  Journal 
of  the  Arkansas  Medical  Society. 

Appointment  of  Reference  Committee. 


REPORT  OF  COMMITTEES 

SCIENTIFIC  WORK— L.  L.  Purif  oy,  Chairman. 

MEDICAL  LEGISLATION — Val  Parmley,  Chairman. 
HEALTH  AND  PUBLIC  I N ST  RUCTION — W.  B.  Gray- 
son, Chairman. 

MEDICAL  EDUCATION  AND  HOSPITALS— Joe  F.  Shuf- 
field,  Chairman. 

PUBLIC  RELATIONS — D.  A.  Rhinehart,  Chairman. 
MEDICAL  ECONOMICS — I.  F.  Jones,  Chairman. 
SCIENTIFIC  EXHIBIT— F.  H.  Krock,  Chairman. 
NECROLOGY — W.  H.  Mock,  Chairman. 

CANCER  CONTROL — D.  W.  Goldstein,  Chairman. 
ARRANGEMENTS — D.  W.  Goldstein,  Chairman. 


REPORT  OF  THE  COUNCIL — S.  J.  Wolfermann,  Chair- 
man. 

ADVISORY  COMMITTEE  TO  THE  EMERGENCY  RELIEF 
ADMINISTRATION — M.  E.  McCaskill,  Chairman. 

REPORT,  OF  THE  STATE  MEDICAL  BOARD  OF  THE 
ARKANSAS  MEDICAL  SOCIETY— A.  S.  Buchanan, 
Secretary. 

REPORT  OF  DELEGATE  TO  THE  AMERICAN  MEDICAL 
ASSOCIATION — L.  J.  Kosminsky. 

REPORT  OF  FRATERNAL  DELEGATES. 

REPORT  OF  THE  TREASURER. 

REPORT  OF  THE  SECRETARY. 

NEW  BUSINESS. 

SELECTION  OF  THE  NOMINATING  COMMITTEE. 

SELECTION  TO  FILL  VACANCIES  ON  THE  STATE 
MEDICAL  BOARD  OF  THE  ARKANSAS  MEDICAL 
SOCIETY.  (Report  to  be  made  at  the  final  general 
session.)  Terms  expiring:  W.  A.  Snodgrass,  Little  Rock; 
W.  W.  Verser,  Harrisburg,  and  W.  W.  York,  Ashdown. 
Drs.  Verser  and  York  have  served  eight  years  which, 
according  to  law,  eliminates  them  from  further  service. 


SCIENTIFIC  SESSION 

MONDAY,  APRIL  15,  1:30  P.  M. 

CALLING  THE  SOCIETY  TO  ORDER— F.  O.  Mahony, 
President. 

INVOCATION — Rev.  H.  C.  Henderson,  First  Methodist 
Church. 

ADDRESS  OF  WELCOME — Hon.  Jim  Jordan,  Mayor  of 
Fort  Smith. 

ADDRESS  OF  WELCOME  ON  BEHALF  OF  SEBASTIAN 
COUNTY  MEDICAL  SOCIETY— F.  H.  Krock,  Fort 
Smith. 

RESPONSE  ON  BEHALF  OF  THE  ARKANSAS  MEDICAL 
SOCIETY — W.  T.  Wootton,  Hot  Springs  National  Park. 

President’s  Annual  Address. 

"The  Functions  of  the  American  Medical  Association," 
Walter  L.  Bierring,  President,  American  Medical  Asso- 
ciation, Des  Moines. 

"Some  Diagnostic  Problems  in  Diseases  of  the  Lungs" — 
S.  E.  Thompson,  President,  Texas  State  Medical  Asso- 
ciation, Kerrville,  Texas. 

"The  Problem  of  Malaria" — W.  B.  Grayson,  Little  Rock. 

"The  Use  and  Abuse  of  Digitalis" — A.  G.  Sullivan,  Hot 
Springs  National  Park. 

“Vaginal  Hysterectomy  with  the  Original  Pryor  Clamp" 
— H.  D.  Wood,  Fayetteville. 


NOTICE 

Stenographic  report  of  discussions  will  not  be  available 
for  the  1935  annual  session.  This  is  in  line  with  the  prac- 
tice of  a number  of  medical  societies  and  is  in  effect  for 
the  1935  session  as  an  experimental  measure.  Discussants 
are  requested,  therefore,  to  furnish  a summary  of  their 
remarks  to  the  editor  at  their  earliest  convenience  in  or- 
der that  the  discussion  may  be  published  with  the  paper 
in  The  Journal. 


April,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


203 


EVENING  SESSION 

(Open  to  the  Public) 

SENIOR  HIGH  SCHOOL  AUDITORIUM, 

23rd  and  "B"  Streets 
8:00  P.  M. 

CALLING  THE  MEETING  TO  ORDER— F.  H.  Knock,  Pres- 
ident, Sebastian  County  Medical  Society. 

INVOCATION — Rev.  Carleton  D.  Lathrop,  St.  John's  Epis- 
copal Church. 

INTRODUCTION  OF  DISTINGUISHED  GUESTS— F.  O. 
Mahony,  President,  Arkansas  Medical  Society. 

ADDRESS — Mrs.  Rogers  N.  Herbert,  Nashville,  Tennessee, 
President,  Woman's  Auxiliary  to  the  American  Medical 
Association — "The  Woman's  Auxiliary  and  the  Medical 
Profession." 

ADDRESS — Walter  L.  Bierring,  M.  D.,  Des  Moines,  Presi- 
dent, American  Medical  Association — "The  Doctor  and 
Plans  for  Economic  Security." 


MEMORIAL  SESSION 

TUESDAY,  APRIL  16,  8:30  A.  M. 

Joint  Session  with  the  Auxiliary 
Goldman  Hotel 

CALLING  MEETING  TO  ORDER— President  Mahony. 
INVOCATION — Rev.  J.  W.  Hickman,  First  Presbyterian 
Church. 

MUSICAL  SELECTIONS — Southwestern  Studios  of  Mu- 
sical Art. 

MEMORIAL  ADDRESS — W.  H.  Mock,  Prairie  Grove. 
MUSICAL  SELECTIONS — Southwestern  Studios  of  Mu- 
sical Art. 

BENEDICTION. 


DECEASED  MEMBERS 

William  Edward  Hughes,  Pocahontas,  March  27,  1934. 
Spencer  Allen  Collom,  Texarkana,  April  26,  1934. 
Oleander  Howton,  Luxora,  Mary  7,  1934. 

David  A.  Hutchinson,  Nashville,  May  27,  1934. 

Miles  Dawson  Kelly,  Lonoke,  June  II,  1934. 

William  H.  McKie,  Wynne,  June  13,  1934. 

Benjamin  F.  Tarver,  Star  City,  June  20,  1934. 

Othello  Moreno  Bourland,  Van  Buren,  June  28,  1934. 
James  Vance  Ferguson,  El  Dorado,  July  8,  1934. 

Walton  W.  Lowe,  Gillett,  September  16,  1934. 

Frank  C.  Robinson,  Little  Rock,  September  19,  1934. 
Arthur  Gilbert  Harrison,  Searcy,  October  5,  1934. 

Edward  Walker  Blackburn,  Ozark,  October  31,  1934. 
Charles  Edward  Park,  DeWitt,  November  20,  1934. 

Elam  Hensley  Stevenson,  Fort  Smith,  November  20,  1934. 
Warren  Laws  Snider,  Hot  Springs  National  Park,  Decem- 
ber 12,  1934. 

William  Hunt  Blankenship,  Pine  Bluff,  December  12,  1934. 
Frank  E.  Hurrle,  Little  Rock,  January  14,  1935. 

William  H.  Miller,  Little  Rock,  January  24,  1935. 

Virgil  L.  Pascoe,  Newark,  January  29,  1935. 

Leslie  A.  Purifoy,  El  Dorado,  January  26,  1935. 

Phillip  Ross  Watkins,  Mena,  February  24,  1935. 

James  Wiley  Slaughter,  Kilgore,  Texas,  March  17,  1935. 
William  Noah  Elkins,  Junction  City,  March  17.  1935. 


SCIENTIFIC  SESSION 

TUESDAY,  APRIL  16,  9:30  A.  M. 

"Appendicitis  in  Childhood" — Eugene  Rosamond,  Mem- 
phis. 

"Cicatricial  Stenosis  of  the  Oesophagus" — Lucian  H.  Lan- 
dry, New  Orleans. 

"Fractures  About  the  Elbow" — Val  Parmley,  Little  Rock. 

"Underwater  Therapy  in  the  Treatment  of  Chronic  Arthri- 
tis" (Motion  picture  presentation) — Euclid  M.  Smith, 
Hot  Springs  National  Park. 

"A  Review  of  300  Cases  of  Breast  Tumors" — M.  J.  Kilbury, 
Little  Rock. 


SCIENTIFIC  SESSION 

TUESDAY,  APRIL  16,  1:30  P.  M. 

"Types  of  Neurosyphilis  Benefited  by  Malaria  Therapy" — 
Paul  A.  O'Leary,  Rochester,  Minnesota. 

"Practical  Management  of  the  Asthmatic  Child" — Ralph 
Bowen,  Oklahoma  City. 

"Further  Studies  in  Prostatic  Resection" — H.  Fay  H.  Jones 
and  T.  Duel  Brown,  Little  Rock. 

"Hysetria  in  General  Practice" — F.  P.  Hardy,  Searcy. 
"Undulant  Fever" — H.  A.  Dishongh,  Little  Rock. 
"Management  of  Pertussis" — Robert  Hood,  Russellville. 


SCIENTIFIC  SESSION 

WEDNESDAY,  APRIL  17,  9:00  A.  M. 

"Cancer  of  the  Rectum:  Factors  Affecting  Its  Cure" — 
(Motion  picture  presentation) — G.  V.  Brindley,  Scott 
and  White  Clinic,  Temple,  Texas. 

"Goitre" — (Motion  picture  presentation) — John  M.  Smith, 
Russellville. 

"Recent  Advances  in  Gynecology" — Ralph  A.  Reis,  Chi- 
cago. 

"Bandl's  Ring" — Ernest  Harl  White,  Little  Rock. 

"Femoral  Hernia  with  Unusual  Contents" — O.  J.  T.  Johns- 
ton, Batesville. 

"Malaria" — M.  S.  Dibrell,  Van  Buren. 

"Vertigo" — Pat  Murphey,  Little  Rock. 


AFTERNOON  SESSION 

FINAL  MEETING  OF  THE  HOUSE  OF  DELEGATES 
GOLDMAN  HOTEL,  APRIL  17,  1:30  P.  M. 

CALLING  MEETING  TO  ORDER— F.  O.  Mahony,  Presi- 
dent. 

ROLL  CALL. 

REPORT  OF  NOMINATING  COMMITTEE. 

ELECTION  OF  OFFICERS: 

President-Elect. 

First  Vice-President. 

Second  Vice-President. 

Third  Vice-President. 

Secretary. 

T reasurer. 

Five  Councilors. 

Delegate  to  the  A.  M.  A. 


204 


THE  JOURNAL  OF  THE 


[Voi.  xxxi,  No.  n 


REPORT  OF  THE  COMMITTEES. 
FURTHER  NEW  BUSINESS. 
ADJOURNMENT. 


FINAL  GENERAL  SESSION 

WEDNESDAY  AFTERNOON,  APRIL  17 
(Immediately  after  adjournment  of  the 
House  of  Delegates) 

CALLING  MEETING  TO  ORDER— F.  O.  Mahony,  Presi- 
dent. 

UNFINISHED  BUSINESS. 

REPORT  OF  THE  REFERENCE  COMMITTEE. 
PRESENTATION  OF  PRESIDENT  M.  E.  McCASKILL. 
PRESENTATION  OF  PRESIDENT-ELECT. 

NEW  BUSINESS. 

SELECTION  TO  FILL  VACANCIES  ON  THE  STATE 
BOARD  OF  MEDICAL  EXAMINERS. 

SELECTION  OF  PLACE  OF  NEXT  MEETING. 
ADJOURNMENT  SINE  DIE. 


PROCEEDINGS  OF  SOCIETIES 


The  February  meeting  of  the  Little  River 
County  Medical  Society  was  held  jointly  with 
the  dentists,  druggists  and  health  workers  of  the 
county  with  speakers  from  each  profession.  Of- 
ficers elected  for  1935  were:  President,  P.  H. 
Phillips:  Secretary-treasurer,  J.  W.  Ringgold; 
Delegate,  H.  Castile;  Alternate,  P.  H.  Phillips. 


A preliminary  organization  meeting  of  the 
Arkansas  State  Pediatric  Association  was  held 
in  Little  Rock  on  March  6th  by  the  following: 
C.  B.  Billingsley,  Fort  Smith;  G.  D.  Murphy,  El 
Dorado;  A.  C.  Kirby,  Little  Rock;  Sam  Phillips, 
Little  Rock;  V.  T.  Webb,  Little  Rock;  Irving  Spitz- 
berg,  Little  Rock;  Charles  Wallis,  Little  Rock; 
J.  E.  Jones,  Little  Rock;  Morgan  Smith,  Little 
Rock;  Madeline  Melson,  Little  Rock;  and  E.  C. 
McMullen,  Pine  Bluff.  The  objects  and  purposes 
of  the  Society  as  set  forth  in  the  constitution 
are:  "To  bring  into  closer  relationship  the  pedia- 
tricians of  the  state  and  those  especially  in- 
terested in  the  life  and  care  of  the  child;  That 
members  of  this  Society  may,  through  organiza- 
tion and  association,  be  stimulated  to  espouse 
sound  and  thorough  pediatric  education  and  be 
encouraged  to  maintain  the  highest  standards 
in  pediatric  practice;  that  there  may  be  a better 
co-operation  with  local,  state,  federal  and  other 
approved  agencies  devoted  to  the  promotion 
of  child  welfare;  that  the  stimulation  of  the  in- 


terest of  the  general  practitioner  in  the  prob- 
lems of  child  life  may  be  increased  and  post- 
graduate study  in  pediatrics  encouraged."  Mem- 
bership is  not  limited  to  those  who  limit  their 
work  to  pediatrics,  provision  being  made  for  the 
admission  of  those  physicians  who  are  especially 
interested  in  the  life  and  care  of  the  child,  who 
may,  through  associate  membership,  enjoy  the 
clinical  privileges  of  the  Society.  The  first  an- 
nual meeting  will  be  held  at  Fort  Smith  on  the 
morning  of  April  15th  and  similar  annual  meet- 
ings will  be  held  at  the  place  and  time  of  the 
annual  session  of  the  Arkansas  Medical  Society. 
Officers  are:  Morgan  Smith,  Chairman,  and 
Madeline  Melson,  Secretary. 


The  St.  Francis  County  Medical  Society  held 
its  annual  meeting  at  Forrest  City  during  Feb- 
ruary, a dinner  preceding  the  program.  Speakers 
were:  R.  Longest,  Wynne;  J.  O.  Rush,  Forrest 
City;  W.  B.  Grayson,  Little  Rock;  Russell  Hen- 
nessey, Memphis,  and  F.  Vinsonhaler,  Little  Rock. 
Officers  elected  are:  President,  C.  V.  Powell, 
Round  Pond;  Vice-President,  H.  L.  McLendon, 
Palestine;  Secretary-treasurer,  J.  O.  Rush,  For- 
rest City;  Delegate,  W.  A.  Winter,  Widener; 
and  Alternate,  H.  L.  McLendon,  Palestine. 

J.  O.  RUSH,  Secretary. 


The  Faulkner  County  Medical  Society  was  ad- 
dressed February  21st  by  R.  L.  Saxon,  Little 
Rock,  on  "The  Pathology,  Diagnosis  and  Treat- 
ment of  Cancer  of  the  Uterus." 


The  Crawford  County  Medical  Society  met 
at  Van  Buren  February  26th.  Dr.  Fount  Richard- 
son, Fayetteville,  acting  district  health  officer, 
explained  the  plan  for  a district  health  unit  to 
be  composed  of  Crawford,  Benton  and  Wash- 
ington counties. 


The  Benton  County  Medical  Society  met  Feb- 
ruary 21st  as  the  guests  of  J.  T.  Powell,  of 
Gravette,  for  a dinner  meeting.  Drs.  Clyde 
McNeil  and  J.  T.  Powell  were  speakers  on  the 
scientific  program. 


The  Pope-Yell  County  Medical  Society  was  ad- 
dressed at  its  March  7th  meeting  held  in  Dan- 
ville by  Geo.  F.  Jackson,  Little  Rock,  on  "Com- 
mon Skin  Diseases." 


April,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


205 


The  Lawrence  County  Medical  Society  met 
at  Walnut  Ridge  February  12th  with  the  follow- 
ing scientific  program:  'Roentgen-ray  Treat- 

ment of  Carbuncle,"  J.  C.  Hughes,  Hoxie,  and 
"Treatment  of  Pneumonia,"  W.  W.  Hatcher, 
Imboden. 

CHAS.  D.  TIBBELS,  Secretary. 


The  Ouachita  County  Medical  Society  was  ad- 
dressed on  March  6th  by  Randolph  Smith,  Sam 
Phillips  and  J.  S.  Levy,  of  Little  Rock,  and  L.  L. 
Purifoy,  El  Dorado.  A motion  picture,  "Malaria," 
was  presented. 


S.  C.  Fulmer  and  M.  J.  Kilbury,  Little  Rock, 
addressed  the  Monroe  County  Medical  Society 
March  14th  at  Brinkley. 

The  Sixth  Councilor  District  Medical  Society 
and  the  Tri-County  Clinical  Society  met  in  joint 
session  at  Prescott  March  12th.  The  following 
scientific  program  was  presented: 

Address — F.  O.  Mahony,  El  Dorado. 

"Errors  in  Treatment  of  Fractures  of  the  Long 
Bones,"  Guy  A.  Caldwell,  Shreveport. 

"Personal  Ideas  of  the  Prostatic  Question,"  Wm. 
Hibbitts,  Texarkana. 

"Common  Skin  Diseases,"  Geo.  F.  Jackson,  Lit- 
tle Rock. 

"Care  and  Feeding  of  Infants,"  E.  C.  Mitchell, 
Memphis. 

"Cancer  of  the  Large  Bowel,"  H.  W.  Hundling, 
Little  Rock. 

"Undulant  Fever,"  S.  C.  Fulmer,  Little  Rock. 
"Streptoccic  Infection  and  Septicemia,"  M.  J. 
Kilbury,  Little  Rock. 

"Tuberculosis,"  J.  D.  Riley,  State  Sanatorium. 

S.  B.  Hinkle,  Little  Rock,  also  addressed  the 
meeting,  and  a motion  picture  film,  "Cancer 
Control,"  was  exhibited. 


Benton  County  Medical  Society  was  addressed 
at  its  March  14th  meeting  by  J.  A.  Foltz,  Fort 
Smith,  on  "Health  Insurance  in  Medicine." 


Washington  County  Medical  Society  met  at 
the  Veterans  Administration  Facility,  Fayette- 
ville, March  13th,  for  a presentation  of  the  film, 
"Insulin,"  furnished  by  Eli  Lilly  and  Company. 
About  400  persons,  including  nurses,  pre-med- 
ical students  and  other  persons  interested  in 
diabetes,  were  present  in  addition  to  the  mem- 
bers of  the  society.  W.  A.  Jones,  Fayetteville, 
has  been  elected  a member  of  the  society. 

FOUNT  RICHARDSON,  Secretary. 


PERSONALS  AND  NEWS  ITEMS 

B.  E.  Hendrix,  Gillham,  has  been  elected  pres- 
ident of  the  newly-organized  Horatio  State  Bank. 

Dr.  and  Mrs.  J.  S.  Rinehart,  Camden,  spent 
the  month  of  February  on  vacation  in  Califor- 
nia. 

W.  A.  Purifoy,  Chidester,  is  recovering  from 
a prolonged  illness. 

N.  G.  Partee,  Stephens,  has  recovered  from 
an  illness  which  required  hospitalization  in  the 
Camden  hospital. 

J.  S.  Wilson,  Monticello,  has  installed  in  the 
Mack  Wilson  Hospital  a 200  Kv.,  25  Ma.  deep 
therapy  unit. 

W.  M.  Blackshare,  Hot  Springs  National  Park, 
addressed  the  Lion's  Club  February  21st  on 
sterilization  laws. 


The  Physicians  Business  and  Credit  Rating  Bu- 
reau of  Jonesboro  has  been  organized  with  the 
following  officers:  President,  Ralph  M.  Sloan; 
Vice-President,  H.  A.  Stroud,  Sr.,  and  Board  of 
Governors,  P.  W.  Lutterloh,  R.  H.  Willett,  R.  M. 
Jernigan,  W.  C.  Overstreet  and  J.  T.  Altman. 


F.  H.  Krock,  Fort  Smith,  addressed  the  Dis- 
trict meeting  of  the  American  College  of  Sur- 
geons held  in  Kansas  City  March  13th  on  "Indi- 
cations for  the  Surgical  Treatment  of  Pulmonary 
Tuberculosis." 


Jaundice  as  a Symptom,"  by  O.  C.  Melson, 
Little  Rock,  appeared  in  the  March  Southern 
Medical  Journal. 


MARRIED — Chas.  E.  Kennedy  and  Miss  Mary 
Johnson,  both  of  Smackover,  on  March  29th. 
The  Journal  offers  congratulations. 

David  Levine,  El  Dorado,  addressed  the  Self 
Culture  Club  of  that  city,  March  7th,  on  "Mod- 
ern Methods  of  Diagnosis." 

Recently  appointed  by  the  Governor  were: 
C.  S.  Holt,  Fort  Smith,  Trustee,  Arkansas  Tu- 
berculosis Sanatorium;  B.  D.  Luck,  Pine  Bluff, 
Member,  Board  of  Nurse  Examiners;  and  P.  M. 
Smith,  Magnolia,  Trustee,  Magnolia  A.  & M. 
College. 


206 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  I I 


J.  C.  Ogden,  Fort  Smith,  took  postgraduate 
work  at  Washington  University  in  February. 

O.  J.  T.  Johnston  addressed  the  Batesville 
American  Legion  Post  in  February. 

Dr.  Milton  John,  a graduate  of  the  University 
of  Arkansas  Medical  School  in  1933,  is  now  as- 
sociated in  practice  with  his  father,  Dr.  M.  C. 
John,  at  Stuttgart. 

The  following  attended  the  District  Meeting 
of  the  American  College  of  Surgeons  in  Kansas 
City  during  March:  H.  C.  Dorsey,  Fort  Smith;  E. 
F.  Ellis,  Fayetteville;  R.  M.  Eubanks,  Little  Rock; 
L.  Gardner,  Russellville;  S.  B.  Hinkle,  Little  Rock; 
J.  S.  Jenkins,  Pine  Bluff;  H.  Fay  H.  Jones,  Little 
Rock;  F.  H.  Krock,  Fort  Smith,  Clyde  McNeil, 
Rogers;  W.  H.  Mock,  Prairie  Grove;  H.  Moul- 
ton, Fort  Smith;  R.  L.  Smith,  Russellville;  W.  F. 
Smith,  Little  Rock;  Joe  F.  Shuffield,  Little  Rock, 
and  B.  L.  Ware,  Greenwood. 

H.  Moulton,  Fort  Smith,  was  the  guest  of  the 
Dallas  Southern  Clinical  Society,  conducting  the 
round  table  luncheon  for  opthalmologists  bn 
March  20th  and  a clinic  on  "Cataract"  March 
2 I st. 


J.  A.  Foltz,  Fort  Smith,  addressed  the  Van 
Buren  Lions  Club  March  13th  on  "Nobel  Prize 
Awards  in  Medicine." 


J.  M.  Taylor,  Fort  Smith,  has  resumed  prac- 
tice after  an  illness  of  several  months. 

J.  D.  Riley,  State  Sanatorium,  addressed  the 
Men's  Club  of  the  First  Presbyterian  Church  of 
Fort  Smith  March  22nd  on  "Tuberculosis." 

In  attendance  at  the  1935  session  of  the  Dal- 
las Southern  Clinical  Society  were:  C.  E.  Bene- 
field, H.  Moulton,  Fort  Smith;  I.  G.  Jones,  De- 
Queen;  Joe  F.  Rushton,  Magnolia,  and  R.  C. 
Shanlever,  Jonesboro. 

"The  Problem  of  Diagnosis  of  Diseases  in 
Their  Incipiency,"  by  L.  H.  Lanier,  Texarkana, 
appeared  in  the  March  Tri-State  Journal. 

Pulaski  County  Medical  Society  was  addressed 
March  22nd  by  Louis  Hamman,  of  Baltimore,  on 
"Heart  Pain,"  and  Douglas  Quick,  New  York,  on 
"Radiation  Therapy  in  Cancer." 

BORN — To  Dr.  and  Mrs.  L.  S.  Dunaway,  Jr., 
of  Conway,  a son,  Louis  S.  Dunaway,  III.  Con- 
gratulations! 


AUXILIARY  NEWS 


PRESIDENT’S  PRE-CONVENTION  MESSAGE 

This  year  in  order  that  we  might  have  an  educational 
as  well  as  a social  program,  two  of  our  national  officers 
have  been  invited  to  speak  to  the  Auxiliary  meeting — 
Mrs.  Rogers  N.  Herbert,  President,  Woman's  Auxiliary 
to  the  American  Medical  Association,  and  Mrs.  David  S. 
Long,  Chairman,  Public  Relations  Committee  of  the 
Woman's  Auxiliary  to  the  American  Medical  Association. 

On  Monday,  April  15th,  many  important  matters  will 
be  discussed.  County  Presidents  and  Delegates  are 
asked  to  please  be  present.  A new  feature  this  year 
will  be  the  county  president's  luncheon  on  this  day,  with 
Mrs.  David  S.  Long  as  the  speaker.  This  luncheon  is  open 
to  all  members  but  county  presidents,  county  presidents- 
elect  and  executive  board  members  are  especially  urged 
to  attend. 

There  will  be  many  social  features  as  many  of  you 
will  attest  to  the  charming  hospitality  of  the  Sebastian 
County  Medical  Society  and  Auxiliary. 

All  visiting  ladies  and  wives  of  physicians  in  attend- 
ance at  the  state  meeting  are  invited  to  attend  the 
meetings  of  the  Auxiliary,  whether  members  of  the  Auxil- 
iary or  not.  M RS.  WM.  HIBBITTS,  President. 


The  Medical  Auxiliary,  Bowie  and  Miller  Counties,  met 
February  22nd,  at  the  home  of  J.  F.  Williams,  with  Mrs. 
H.  H.  Smiley,  Mrs.  E.  M.  Watts,  Mrs.  William  Hibbitts 
and  Mrs.  H.  R.  Webster,  co-hostesses. 

Mrs.  Decker  Smith,  President,  presided. 

Resolutions  upon  the  death  of  Mrs.  Preston  Hunt,  a be- 
loved member,  were  read  by  Mrs.  Harry  Murry,  followed 
by  a prayer  by  Mrs.  J.  T.  Robinson.  Announcement  of  a 
contest  to  be  held  in  the  Junior  High  (Public  and  Pa- 
rochial) schools  of  the  city  was  made,  the  subject  being 
"Communicable  Diseases." 

Mrs.  H.  P.  Phillips  of  Ashdown  led  the  program,  her 
subject  being  "Review  of  the  Past  Twelve  Years’  Work  in 
the  Auxiliary."  Mrs.  William  Hibbitts  then  told  of  her 
work  as  State  President  in  Arkansas. 

The  Woman's  Auxiliary  to  the  Pulaski  County  Medical 
Society  met  March  20th  at  the  home  of  Mrs.  K.  W.  Cos- 
grove. Co-hostesses  were:  Mesdames  Frank  O.  Rogers, 
Geo.  F.  Jackson,  S.  P.  Junkin  and  Clyde  Rodgers. 

The  Obstetrical  Pack  Committee  of  the  Woman's  Aux- 
iliary to  the  Pulaski  County  Medical  Society  met  March 
13th  at  the  home  of  Mrs.  M.  E.  McCaskill.  Mesdames  J. 
B.  Crawford,  President;  B.  A.  Bennett,  C.  E.  Oates,  D.  M. 
Switzer,  A.  C.  Shipp,  Harvey  Shipp,  R.  A.  Law,  S.  C.  Ful- 
mer and  L.  F.  Barrier  were  present.  Following  the  work 
session  refreshments  were  served  by  the  hostess. 

The  Woman's  Auxiliary  to  the  Sebastian  County  Medical 
Society  met  March  18th  at  the  home  of  Mrs.  M.  E.  Fos- 
ter. Plans  for  the  state  meeting  were  discussed  and  the 
following  officers  elected:  President,  Mrs.  Pierre  Redman; 
Vice-president,  Mrs.  J.  E.  Stevenson;  Secretary,  Mrs.  H.  C. 
Dorsey;  and  Treasurer,  Mrs.  B.  B.  Bruce. 

The  Woman's  Auxiliary  to  the  Arkansas  Medical  Society 
has  been  honored  by  the  invitation  extended  to  its  Presi- 
dent, Mrs.  Wm.  Hibbitts,  to  respond  to  the  address  of 
welcome  at  the  meeting  of  the  Woman's  Auxiliary  to  the 
American  Medical  Association  in  Atlantic  City  June  10-14. 


April,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


207 


WOMAN'S  AUXILIARY 

TO  THE 

ARKANSAS  MEDICAL  SOCIETY 
ELEVENTH  ANNUAL  MEETING 

APRIL  15,  16,  17,  1935 

FORT  SMITH,  ARKANSAS 

HEADQUARTERS:  WARD  HOTEL 


OFFICERS 

PRESIDENT — Mrs.  William  Hibbitts,  Texarkana. 
PRESIDENT-ELECT — Mrs.  Marcus  T.  Smith,  Conway. 
FIRST  VICE-PRESIDENT  — Mrs.  Chas.  E.  Garrett,  Hot 
Springs  National  Park. 

SECOND  VICE-PRESIDENT— Mrs.  R.  C.  Dorr,  Batesville. 
THIRD  VICE-PRESIDENT — Mrs.  Anderson  Watkins,  Little 
Rock. 

FOURTH  VICE-PRESIDENT — Mrs.  J.  B.  Jameson,  Camden. 
SECRETARY — Mrs.  H.  E.  Murry,  Texarkana. 

TREASU  RER— M rs.  L.  J.  Kosminsky,  Texarkana. 

PUBLICITY  SECRETARY— Mrs.  D.  W.  Goldstein,  Fort 
Smith. 

HISTORIAN — Mrs.  C.  W.  Garrison,  Little  Rock. 
PARLIAMENTARIAN — Mrs.  F.  M.  Williams,  Hot  Springs 
National  Park. 

COUNCILORS 

Mrs.  B.  A.  Rhinehart,  Little  Rock. 

Mrs.  P.  H.  Phillips,  Ashdown. 

Mrs.  W.  R.  Brooksher,  Fort  S mith. 

Mrs.  Chas.  E.  Oates,  Little  Rock. 

Mrs.  C.  G.  Hinkle,  Batesville. 

ADVISORY  BOARD 

L.  J.  Kosminsky,  Texarkana. 

W.  T.  Wootton,  Hot  Springs  National  Park. 

C.  S.  Holt,  Fort  Smith. 

COMMITTEE  CHAIRMEN— 1 934-35 

ORGANIZATION — Mrs.  Chas.  E.  Garrett,  Hot  Springs 
National  Park. 

EDUCATION  AND  PUBLIC  HEALTH— Mrs.  J.  T.  McLain, 
Gurdon. 

ILSE  F.  OATES  LOAN  FUND— Mrs.  Chas.  E.  Oates,  Lit- 
tle Rock. 

HYGEIA — Mrs.  B.  A.  Bennett,  Little  Rock. 
CONSTITUTION  AND  BY-LAWS— Mrs.  S.  A.  Collom, 
Texarkana. 

PUBLIC  RELATIONS — Mrs.  Pierre  Redman,  Fort  Smith. 
MEMORIAL — Mrs.  C.  G.  Hinkle,  Batesville. 

FINANCE — Mrs.  Curtis  Jones,  Benton. 

EXHIBITS — Mrs.  C.  A.  Archer,  DeQueen. 

PHYSICAL  HEALTH  EXAM  I NATION— Mrs.  L.  H.  Lanier, 
Texarkana. 

JANE  TODD  CRAWFORD  MEMORIAL— Mrs.  E.  A.  Cal- 
lahan, Carlisle. 

ARCHIVES — Mrs.  T.  G.  Porter,  Hazen. 

PROGRAM — Mrs.  D.  W.  Goldstein,  Fort  Smith. 
CREDENTIALS — Mrs.  B.  W.  Freer,  Fort  Smith. 

LOCAL  COMMITTEES 

GENERAL  CHAIRMAN— Mrs.  W.  R.  Brooksher. 
ENTERTAINMENT— Mrs.  M.  E.  Foster. 

DECORATIONS— Mrs.  A.  F.  Hoge. 

LUNCHEON— Mrs.  E.  C.  Moulton,  Mrs.  C.  S.  Holt,  Mrs. 
Pierre  Redman. 

PROGRAM — Mrs.  D.  W.  Goldstein,  Mrs.  A.  A.  Blair. 
TEA — Mrs.  S.  J.  Wolfermann,  Mrs.  J.  C.  Amis,  Mrs.  J.  A. 
Foltz. 


COURTESY — Mrs.  I.  F.  Jones,  Mrs.  J.  S.  Southard,  Mrs. 
A.  S.  Chapman,  Mrs.  Fred  Krock,  Mrs.  B.  B.  Bruce,  Mrs.. 
H.  W.  Savery. 

PUBLICITY— Mrs.  W.  F.  Rose. 

TRANSPORTATION— Mrs.  W.  G.  Eberle. 

REGISTRATION  AND  CREDENTIALS— Mrs.  B.  W.  Freer, 
Mrs.  C.  S.  Bungart,  Mrs.  S.  P.  Stubbs,  Mrs.  G.  G.. 
Woods. 


PROGRAM 

MONDAY,  APRIL  15 
Ward  Hotel 

8:30  A.  M.— REGISTRATION. 

10:00  A.  M.— EXECUTIVE  BOARD  MEETING. 

12:00  M.  —COUNTY  PRESIDENT'S  LUNCHEON. 

ADDRESS — Mrs.  David  Long,  Chairman,. 
Public  Relations  Committee,  Woman's 
Auxiliary  to  the  American  Medical  As- 
sociation, Harrisonville,  Missouri — "What- 
Now,  Auxiliary  Women?" 

ROUND  TABLE  DISCUSSION. 

1:30  P.  M.— GENERAL  SESSION. 

CALLING  MEETING  TO  ORDER— Mrs.  J. 
E.  Stevenson,  President,  Woman's  Auxil- 
iary to  the  Sebastian  County  Medical' 
Society. 

INVOCATION — Rabbi  Samuel  Teitelbaum, 
Fort  Smith. 

ADDRESS  OF  WELCOME— Mrs.  E.  C 
Moulton,  Fort  Smith. 

RESPONSE  TO  ADDRESS  OF  WELCOMF 
- — Mrs.  L.  T.  Evans,  Batesville. 

INTRODUCTION  OF  STATE  PRESIDENT— 
Mrs.  Wm.  Hibbitts,  Texarkana. 

INTRODUCTION  OF  HONOR  GUESTS. 

ANNOUNCEMENTS  OF  SPECIAL  COM- 
MITTEES. 

REPORT  OF  REGISTRATION  COMMIT- 
TEE. 

REPORT  OF  ENTERTAINMENT  COM- 
MITTEE. 

REPORT  OF  COMMITTEE  ON  CONSTI- 
TUTION AND  BY-LAWS— Mrs.  S.  A. 
Collom,  Texarkana. 

REPORT  OF  A.  M.  A.  AUXILIARY  MEET- 
ING— Mrs.  B.  A.  Rhinehart,  Little  Rock. 

REPORT  OF  THE  S.  M.  A.  AUXILIARY 
MEETING — Mrs.  T.  G.  Porter,  Hazen. 

4:00-  6:00  P.  M.  TEA — Residence  of  Mrs.  S.  J.  Wolfer- 
mann, 1109  Adelaide  Avenue. 


TUESDAY,  APRIL  !6 

8:30  A.  M.- — MEMORIAL  SERVICE  — Goldman  Hotel. 

(Joint  Session  with  Arkansas  Medical  So- 
ciety.) 


DECEASED  MEMBERS 

Delia  Lock  Preston,  Hot  Springs  National  Park,  September 
9,  1934. 

Sue  Eva  Poynor,  Harrison,  June  13,  1934. 

Gladys  Simon  Kirkpatrick,  Texarkana,  July  20,  1934. 
Hattie  Hutton  Hunt,  Texarkana,  January  27,  1935. 


208 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  I I 


GENERAL  SESSION 

TUESDAY,  APRIL  16 
Ward  Hotel,  Gold  Room 

9:30  A.  M.— CALLING  MEETING  TO  ORDER— Mrs. 
Wm.  Hibbitts. 

READING  OF  MINUTES. 

REPO  RTS- 
State  Officers. 

Standing  Committees. 

ADDRESS— Dr.  F.  O.  Mahony,  El  Dorado, 
President,  Arkansas  Medical  Society. 

ROLL  CALL  AND  REPORTS  OF  COUN- 
TY AUXILIARIES. 

REPORT  OF  CREDENTIALS  COMMIT- 
TEE. 

REPORT  OF  NOMINATING  COMMIT- 

TEE. 

ELECTION  OF  OFFICERS. 

REPORT  OF  RESOLUTIONS  COMMIT- 
TEE. 

1:00  P.  M. — LUNCHEON — Hardscrabble  Country  Club. 

TOASTMISTRESS — Mrs.  J.  E.  Stevenson. 

INTRODUCTION  OF  VISITORS. 

INTRODUCTION  OF  PAST-PRESIDENTS. 

INTRODUCTION  OF  WIVES  OF  STATE 
MEDICAL  SOCIETY  OFFICERS  AND 
STATE  OFFICERS. 

PRESIDENT'S  REPORT. 

VIOLIN  SOLO — Madeline  Marker. 

ADDRESS — Mrs.  Rogers  N.  Herbert,  Nash- 
ville, Tennessee,  President,  Woman's 
Auxiliary  to  the  American  Medical  As- 
sociation-— -"The  New  Deal  and  the  Aux- 
iliary." 

SELECTIONS — Senior  High  School  Boys' 
Quartette. 

UNFINISHED  BUSINESS. 

INSTALLATION  OF  NEW  OFFICERS. 

ADDRESS  OF  INCOMING  PRESIDENT— 
Mrs.  Marcus  T.  Smith,  Conway. 

3:30  P.  M.— POST-CONVENTION  BOARD  MEETING— 
Mrs.  Marcus  T.  Smith,  Presiding. 

WEDNESDAY,  APRIL  17 

9:30  A.  M.— SCENIC  DRIVE  TO  OZARK  MOUNTAINS. 

Cars  will  leave  Ward  Hotel. 


HONOR  GUESTS 

Mrs.  Rogers  N.  Herbert,  Nashville,  Tennessee,  President, 
Woman's  Auxiliary  to  the  American  Medical  Associa- 
tion. 

Mrs.  David  S.  Long,  Harrisonville,  Missouri,  Chairman, 
Public  Relations  Committee,  Woman's  Auxiliary  to  the 
American  Medical  Association. 


COUNTY  PRESIDENTS— 1934-35 

Arkansas — Mrs.  W.  W.  Lowe,  Gillett. 

Clay — Mrs.  W.  O.  Parish,  Rector. 

Columbia — Mrs.  W.  P.  Cooksey,  Magnolia. 

Cross — Mrs.  Austin  F.  Barr,  Cherry  Valley. 

Crittenden — Mrs.  T.  S.  Hare,  Crawfordsville. 
Clark-Hempstead-Nevada — Mrs.  J.  T.  McLain,  Gurdon. 
Faulkner — Mrs.  L.  S.  Dunaway,  Jr.,  Conway. 

Garland — Mrs.  'W.  T.  Wootton,  Hot  Springs  National 
Park. 

Independence — Mrs.  L.  T.  Evans,  Batesville. 

Jefferson — Mrs.  J.  W.  John,  Pine  Bluff. 

Johnson — Mrs.  E.  H.  Hunt,  Clarksville. 

Lonoke-Prairie — Mrs.  T.  E.  Benton,  Lonoke. 

Ouachita — Mrs.  B.  V.  Powell,  Camden. 

Miller — Mrs.  Decker  Smith,  Texarkana. 

Lawrence — Mrs.  P.  C.  Neece,  Walnut  Ridge. 

Pulaski — Mrs.  J.  B.  Crawford,  Little  Rock. 

Pope-Yell — Mrs.  Robert  Hood,  Russellville. 

Saline — Mrs.  E.  A.  Buckley,  Bauxite. 

Sebastian — Mrs.  J.  E.  Stevenson,  Fort  Smith. 

Sevier — Mrs.  C.  E.  Kitchens,  DeQueen. 

Washington — Mrs.  Loyce  Hathcock,  Fayetteville. 

Union — Mrs.  A.  D.  Cathey,  El  Dorado. 

Ninth  Councillor  District — Mrs.  A.  L.  Carter,  Berryville. 


DRUG  OR  RETAIL  SALESMEN 

Calling  regularly  on  dispensing  physicians,  free  to 
accept  non-competing  line.  Liberal  commission 
and  full  protection.  Give  present  line,  territory 
covered,  and  number  of  trips  per  year.  Complete 
co-operation  and  direct  mail  assistance. 

GASTON  MOREAU 

509  Fifth  Avenue  New  York,  N.  Y. 


OTHERS  ASK  UP  TO  $50.00 


THIS  HIGH  GRADE 


TAYLOR  SPINAL  BRACE 


>2000 


OUR 

PRICE 


OTHERS 
ASK  UP  TO 
$10.00 


SACRO  ILIAC  BELT 


OUR  $ ' 
PRICE 


A well  padded  sur- 
gical steel  spinal 
support  furnished 
with  apron  and 
perineal  straps. 

Made  to  order 
in  24  hours 
Take  measurements 
around  iliac  crest, 
umbilicus,  distance 
from  sacro  lumbar 
articulation  to  7th 
cervical  vertebra 
prominence. 


Beautifully  made  of  six  inch 
orthopedic  webbing,  well  rein- 
forced, supplied  with  perineal 
straps. 

Take  measurements  around  the 
hips  three  inches  below  the 
iliac  crest. 

WE  ALSO  MAKE— 

Abdominal  Belts , $3.50  — for 
hernia,  obesity,  maternity, 
ptosis , post-operative. 

Hood  Truss $ 4.00 

Thomas  Leg  Splints  4.00 
Ambulatory  Splint.  _ 15.00 
Cervical  Neck  Brace  20.00 


A.  RITTER  CO. 

310  Woodward  Ave.,  Detroit,  Mich. 


Have 
You  Re- 
ceived O 
New  Catalog? 


April,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


209 


BOOK  REVIEWS 

Manual  of  Radiological  Technique.  By  L.  R.  Sante,  M. 
D.,  Professor  of  Radiology,  Saint  Louis  University  School  of 
Medicine;  Radiologist  to  Saint  Louis  City  Hospital  and 
Saint  Mary's  Hospital,  Saint  Louis.  Paper.  Pp.  157,  with 
141  illustrations.  Ann  Arbor,  Michigan:  Edwards  Bros., 
Inc.,  1934. 

This  volume  distinctly  departs  from  the  usual  method 
of  publishing  by  recourse  to  lithoprinting.  Typewritten 
pages  have  been  lithoprinted  in  a reduced  pica  size  on  a 
heavy  grade  of  paper  while  the  illustrations  are  made  by 
the  offset  lithographic  process.  Roentgenograms  are  re- 
produced in  uniform  density  and  in  good  detail.  The  gen- 
eral appearance  is  most  pleasing.  Space  is  provided  by 
blank  pages  for  additional  special  examinations  of  the 
roentgenologist.  Short  chapters  on  history  and  physics  in- 
troduce the  work.  All  essential  factors  of  roentgenography 
are  fully  discussed.  The  book  aims  for  the  development 
of  a uniform  technic  by  the  technician  and  the  roentgen- 
ologist, presenting  all  standard  positions  with  the  resulting 
roentgenogram  and  a discussion  of  the  factors  on  the 
same  page.  The  roentgenological  consideration  for  each 
position  and  part  examined  is  summarized  and  the  advan- 
tages of  that  particular  view  are  stated.  Sante  has  pro- 
duced an  excellent  handbook,  clear  and  concise;  a definite 
aid  in  developing  a uniform  technic. 


Trademark  f I ^ I)  A/T  Trademark 

Registered  k_7  J_.  .XA_YyJ_  Registered 

Binder  and  Abdominal  Supporter 


Gives  perfect  up- 
lift. Is  worn  with 
comfort  and  satis- 
faction. Made  of 
Cotton,  Linen  and 
Silk;  washable  as 
underwear.  Three 
distinct  types  :and 
many  variations 
of  each.  Belts  de- 
signed according 
to  needs  of  case. 

Picture  Shows  “Type  N” 

For  all  conditions,  as  Ptosis,  Hernia, 
Pregnancy,  Obesity,  Sacroiliac,  Relaxa- 
tions, High  and  Low  Operations,  etc. 

Each  Belt  Made  to  Order — Ask  for  Literature 

KATHERINE  L.  STORM,  M.  D. 

Originator , Owner  and  Maker 
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ACTUAL  PRACTICE  IN  SURGICAL  TECHNIQUE 

WITH  A REVIEW  OF  SURGICAL  ANATOMY 

For  information  as  to  Courses,  Fees,  Registration  requirements,  etc.,  address 
CHICAGO  INSTITUTE  OF  SURGERY 
2040  LINCOLN  AVE.  CHICAGO,  ILL 


GRANITE  MOUNTAIN  HOSPITAL 

Open  to  All  Reputable  Physicians  and  Surgeons 

S.  P.  JUNKIN,  M.  D.,  Medical  Director 
Telephone  Rural  9579-F2  Route  4,  Little  Rock,  Ark. 


ALCOHOLISM  - MORPHINISM 


Successfully  Treated  by  Dr.  B.  B.  Ralph's  Methods 


SCIENTIFICALLY  equipped  for  Diagnostic  Surveys,  Thera- 
peutic Procedures,  Rest  and  Recuperation.  Treaiment  of 
each  case  established  by  clinical  history,  physical  exam- 
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Reasonable  fees. 


33  Years  Established. 
RALPH  EMERSON  DUNCAN.  M.  D. 
Director. 


Address  THE  RALPH  SANITARIUM, 

529  HIGHLAND  AVENUE.  KANSAS  CITY,  MO. 
Telephone.  Victor  4850. 


Please  give  yourself  this 
good  advice,  Doctor 


IN  assuming  responsibility  for  your  patients’  health 
and  well-being,  you  may  be  overlooking  your  own  physi- 
cal condition.  You  work  hard  — harder  than  most  of  us. 
Your  health  is  even  more  important  than  your  patients’. 
You,  more  than  anyone  else,  Doctor,  need  to  keep  your- 
self in  good  condition. 

Many  doctors  drink  Cocomalt  regularly  during  the  day 
because  of  the  extra  food-energy  it  provides,  and  at  night 
before  retiring  because  they  know  that  a hot,  non-stimu- 
lating drink  is  an  aid  to  sound,  restful  sleep. 

Why  many  doctors  use  this  delicious 
food-drink  in  their  own  homes 

Many  doctors  see  to  it  that  their  children  also  drink 
Cocomalt  regularly.  Mixed  with  milk  as  directed,  Coco- 
malt increases  the  protein  content  50%,  carbohydrate 
content  170%,  calcium  content  35%,  phosphorus  content 
70%.  It  is  rich  in  Vitamin  D,  containing  not  less  than 
30  Steenbock  (81  U.S.P.  revised)  units  per  ounce — the 
amount  used  to  make  one  glass  or  cup. 

Cocomalt  is  delicious.  It  is  high  in  food  value — low 
in  "cost.  It  comes  in  powder  form,  easy  to  mix  with  milk 
— HOT  or  COLD.  Sold  at  grocery  and  drug  stores  in 
y2-lb.  and  1-lb.  air-tight  cans.  Also  in  5-lb.  cans  for 
professional  or  hospital  use,  at  a special  price. 


Cocomalt  is  accepted  by  the  Committee  on 
Foods  of  the  American  Medical  Associa- 
tion. Prepared  by  an  exclusive  process  un- 
der scientific  control.  Cocomalt 
is  composed  of  sucrose,  skimr 
milk,  selected  cocoa,  barley  malt  *i 
extract,  flavoring,  and  added  Vi- 
tamin D (irradiated  ergosterol). 


FREE  TO  DOCTORS: 

We  will  be  glad  to  send 
a professional  sample  of 
Cocomalt  to  any  phy- 
sician requesting  it. 
Simply  mail  coupon  with 
your  name  and  address. 


R.  B.  Davis  Co.,  Dept.  SI4 
Hoboken,  N.  J. 

Please  send  me  a trial-size 
of  Cocomalt  without  charge. 


CIGARETTE  SMOKE 

not  necessarily  a cause 
of  IRRITATION 

CONGESTION  of  the  pharynx  and 
larynx  caused  or  accentuated  by 
smoke  from  cigarettes  in  which  glycer- 
ine was  used  as  the  hygroscopic  agent 
showed  improvement  in  all  cases  when 
cigarettes  using  diethylene-glycol  as 
hygroscopic  agent  were  smoked. 

Some  Clinical  Observations  on  the  Influence  of 
certain  Hygroscopic  Agents  in  Cigarettes. 

Laryngoscope,  1935,  XLV,  149-154* 

SEE  ALSO 

Pharmacology  of  Inflammation  : III.  Influence  of 
hygroscopic  agents  on  irritation  from  cigarette  smoke. 
Proc.  Soc.  Exp.  Biol,  and  Med.,  1934, 
32,  241-245* 


The  results  reported  in  these  papers  find 
a practical  application  in  Philip  Morris 
cigarettes,  in  which  only  diethylene-glycol 
is  used  as  the  hygroscopic  agent.  To  any 
Doctor  who  wishes  them  for  himself,  the 
Philip  Morris  Company  will  gladly  mail 
a sufficient  sample  on  request  below.  * * 

For  exclusive  use  of  practising  physicians 

PHILIP  MORRIS  8C  CO.  LTD.  INC. 

119  FIFTH  AVENUE  . NEW  YORK 

Absolutely  without  charge  or  obligation  of  any 
kind,  please  mail  to  me 

* Reprint  of  papers  from  Laryngo-  1 — 1 
scope  1935  XLV,  149-154  and  from  ' — 1 
Proc.  Soc.  Exp.  Biol,  and  Med., 

1934,  32,  241-245. 

★ ★ Two  packages  of  Philip  Morris  I I 
English  Blend  cigarettes. 


NAME.  M.D. 

ADDRESS 

CITY STATE 


THE  COUNCIL  URGES  SUPPORT  OF  JOURNAL  ADVERTISERS 


THE  JOURNAL 

^ of  the  ARKANSAS  MEDICAL  SOCIETY  ^ 

PUBLISHED  MONTHLY  UNDER  DIRECTION  OF  THE  COUNCIL 
Vol.  XXXI  FORT  SMITH,  ARKANSAS,  MAY,  1935  No.  12 


HEALTH  EXAMINATION  IN  RELATION 
TO  CANCER  IN  WOMEN* 

RUTH  ELLIS,  M.  D. 

Fayetteville 


Since  cancer,  because  of  its  insidious  ap- 
proach, can  frequently  be  detected  by  a trained 
physician  before  it  presents  symptoms  to  its  host, 
I have  taken  the  liberty  of  digressing  from  my 
subject,  "What  Women  Should  Know  About 
Cancer,"  to  stress  the  importance  of  examina- 
tions to  prevent  its  occurrence. 

It  was  with  the  greatest  pleasure  that  I pre- 
pared for  your  consideration  this  discussion  of 
Health  in  Women,  for  that  is  what  the  periodic 
.health  examination  insures.  There  is  no  better 
way  of  stressing  its  importance  than  by  pre- 
senting its  consequences  to  the  group  most  vital- 
ly concerned. 

Several  years  ago  the  medical  profession 
faced,  and  to  an  admirable  extent  conquered, 
the  problem  of  prolonging  life.  Now  a new 
problem  presents  itself.  We  must  increase  the 
health  span,  and  thus  the  work  span,  just  as  we 
have  lengthened  the  life  span  of  man. 

"The  woman  who  is  sound  and  healthy  steps 
on  life's  highway  with  a song  in  her  heart,  look- 
ing forward  eagerly  to  life's  adventure,  curious 
to  see  what  is  around  the  next  corner.  To  her, 
life's  struggle  is  stimulating,  attractive.  The 
woman  out  of  health  fears  every  turn  in  the 
road.  There  is  no  song  in  her  breast,  but  a 
flutter  of  apprehension.  She  avoids,  rather  than 
seeks,  life's  struggles. 

"Good  health  is  the  foundation  not  only  of 
bu  siness  success  but  of  successful  living.  Its  in- 
fluence on  personality  is  profound,  and  in  urging 
that  one's  health  assets  be  examined  and  im- 
proved to  the  highest  degree,  we  are  seeking 
to  accomplish  that  which  will  make  life  more 
colorful,  more  satisfying,  and  in  every  way  more 
livable  for  the  great  mass  of  people." 

* Read  before  an  open  meeting  of  the  Woman's 
Auxiliary  to  the  Sebastian  County  Medical  Society,  Fort 
Smith,  February  II,  1935. 


It  is  rather  appalling  to  know  that  while  a man 
or  woman  may  live  to  be  58  years  of  age,  the 
period  of  physical  freedom  and  full  vigor  is  only 
from  I 8 to  3 I years;  and  the  period  of  maximum 
activity  in  industry  is  from  20  to  42  years.  Like- 
wise is  it  disconcerting  to  realize  that  the  sick- 
ness rate  from  35  to  45,  the  years  when  the 
work  of  the  world  is  done,  is  double  that  of  the 
years  I 5 to  34. 

The  periodic  health  examination  movement  is 
in  its  youth,  but  already  a mass  of  experience 
has  accumulated  to  validate  its  worth.  We  all 
know  without  statistics  that  there  is  a huge  eco- 
nomic waste  annually  from  time  lost  from  sick- 
ness, and  we  are  vaguely  aware  that  much  of 
this  could  be  prevented.  But  let  us  face  figures. 
May  I quote  from  one  of  our  insurance  ~om- 
panies  their  demonstration  of  possible  savings 
from  health  supervision  and  periodic  physical  ex- 
amination. 

"The  expected  mortality  per  1000  population 
is  10  lives.  The  number  of  substandard  or  phys- 
ically impaired  per  1000  is  300  lives.  Of  these 
300  substandard  lives  the  expected  mortality  is 
6 lives.  With  examination,  the  expected  mor- 
tality is  reduced  to  3 lives.  This  saving  of  3 
lives  results  in  a saving  to  the  state  of  $29,000 
per  1000  population." 

The  results  of  another  health  survey  are  in- 
teresting. In  examination  of  4,473  people,  77 
per  cent  were  found  either  actually  ill  or  with 
reportable  defects;  64  per  cent  of  these  defects 
were  directly  preventable;  22  per  cent  were  par- 
tially preventable,  while  only  14  per  cent  were 
not  preventable. 

The  Life  Extension  Institute  examined  a typi- 
cal group  of  active  workers,  post-office  em- 
ployees, and  found  none  without  physical  de- 
fects. Five  per  cent  had  moderate  defects  re- 
quiring hygienic  correction;  26  per  cent  had 
moderate  defects  requiring  medical  supervision; 
57  per  cent  had  advanced  physical  impairment 
requiring  systematic  medical  or  surgical  care; 
and  12  per  cent  needed  immediate  surgical  or 
medical  intervention. 

Up  to  1931  the  Metropolitan  Life  Insurance 


212 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  12 


Company  showed  a mortality  18  per  cent 
among  those  who  had  availed  themselves  of  the 
periodic  health  examination.  This  improvement 
was  higher  in  the  older  age  groups,  being  53 
per  cent  in  the  50  to  60-  year  group.  If  it  is 
good  business  for  an  insurance  company  to  pro- 
vide routine  examinations  for  its  policy  holders, 
why  should  it  not  be  good  business  for  us  as 
individuals  to  obtain  well-being  and  longevity? 

In  practically  every  community,  there  is  pro- 
vision for  pre-natal  care,  post-natal  care,  and 
pre-school  examination.  The  school  child  has 
health  supervision,  colleges  provide  student 
health  services,  and  industries  are  forced  from 
the  economic  standpoint  to  safeguard  the  health 
of  employees;  but  of  a group  of  9,000  families 
who  had  periodic  health  examinations  as  sur- 
veyed by  the  United  States  Public  Health  Serv- 
ice, less  than  4 per  cent  were  adults.  One  great 
group  of  persons  escapes  almost  completely  med- 
ical examination  and  care.  Within  this  group 
fall  women  between  the  ages  of  35  and  50,  the 
age  range  wherein  one  is  most  apt  to  find  physi- 
cal impairment  and  substandard  physical  states 
that  pre-dispose  to  acute  and  chronic  disease. 
This  most  important  group  has  been  overlooked, 
the  homemakers  who  contribute  so  much  to  so- 
cial welfare  and  whose  individual  physical  wel- 
fare affects  so  forcibly  the  psychology  of  their 
homes  and  ultimately  the  happiness  of  the  social 
group. 

One  of  this  group,  who  happens  to  be  a nurse, 
says  in  her  new  book,  "So  we  give  you  the 
woman  over  forty!  Freed  by  nature  from  her 
duty  of  child-bearing,  her  family  brought  up,  she 
is  ready  for  the  most  mentally  fruitful  and  so- 
cially profitable  period  of  her  career,  for  the 
luxury  of  living  for  herself.  One  sees  such  women 
everywhere,  in  the  professions,  in  the  art,  in  pub- 
lic life,  full  of  energy,  full  of  accomplishments, 
Shortly  it  will  be  the  exceptional  woman  who 
deems  that  she  has  fulfilled  her  mission  in  life 
when  she  sees  her  children  settled.  It  will  be  the 
usual  thing  for  women  to  make  a neat  division 
of  their  lives,  the  years  up  to  forty  for  growing, 
for  learning,  for  marrying,  for  bearing  children; 
the  late  years  for  self-expression,  for  service,  for 
all  kinds  of  social  and  helpful  activities." 

Yes,  at  forty  may  begin  the  years  of  promise; 
but  also  at  forty  begin  an  increasing  number  of 
organic  defects,  such  as  heart  disease,  arthritis, 
mouth  infections,  conditions  resulting  from  in- 
juries of  childbirth,  and  menopausal  diseases. 
Obesity,  gall-bladder  disease,  diabetes,  and  vis- 
ceral syphilis  also  appear  at  this  age.  And  then 


comes  the  specter  of  modern  medicine,  cancer, 
with  its  insidious  approach,  its  universality  of  ap- 
pearance, and  its  deadly  finality.  Cancer  is 
commonly  found  between  the  ages  of  35  and 
70,  and  is  more  frequent  among  women  than 
men.  This  is  because  it  develops  in  chronically 
irritated  tissues.  Although  the  real  cause  of  ma- 
lignancy is  not  known,  another  pre-disposing  fac- 
tor is  herditary  tendency.  There  is  no  site  that 
is  exempt  from  attack.  Malignancy  may  appear 
in  the  uterus,  on  the  cervix,  the  breast,  under 
the  arm,  on  the  finger,  in  the  stomach,  in  fact, 
in  any  tissue  in  the  body.  It  kills  the  patient 
wherever  it  may  grow.  It  infiltrates  and  destroys 
the  surrounding  parts.  It  sets  up  secondary 
growths  or  metastases  in  neighboring  lymphatic 
glands  and  in  distant  parts  of  the  body,  being 
spread  by  the  blood-stream  or  the  lymphatics. 
It  tends  to  recur  after  incomplete  removal.  Its 
growth  is  relatively  rapid. 

Perhaps  I have  painted  the  picture  too  dark. 
Herein  lies  one  of  the  chief  values  of  the  period- 
ic examination.  The  American  Society  for  the 
Prevention  of  Cancer  has  proved  that  one-third 
of  cancer  cases  can  be  prevented  by  correcting 
irritation.  Out  of  30,000  routine  examinations, 
553  growths  were  found.  Twenty-two  of  these, 
were  malignant  and  I I were  operable  or  cur- 
able. Had  the  examination  been  earlier,  no 
doubt  the  curable  percentage  would  have  been 
higher.  "A  suspicious  mind  and  a good  light," 
when  used  by  a keen  medical  man,  can  often  de- 
tect signs  of  a growth  in  the  very  early  stages. 
At  this  time  steps  can  be  taken  to  avert  fur- 
ther trouble.  Radium  and  X-ray  properly  used 
by  a competent  physician  usually  inhibit  fur- 
ther growth  and  prevent  metastases.  I say 
"properly  used,  and  by  a competent  physician," 
advisedly.  For  improper  or  inadequate  treatment 
is  no  better  than  no  treatment.  For  proper  treat- 
ment, adequate  preparation  is  essential. 

It  is  a fallacy  to  assume  that  we  can  practice 
prevention  only  at  the  cradle  and  keep  a per- 
son perfectly  well  throughout  life.  Constant 
vigilance  is  necessary  to  find  the  first  signs  of 
mal-function,  to  determine  how  to  regain  func- 
tional balance  early,  and  to  prevent  the  so-called 
degenerative  diseases.  We  must  find  and  cor- 
rect those  too  often  simple  defects  which  im- 
pair physical  well-being. 

The  periodic  health  examination  serves  the 
double  purpose  of  first,  checking  the  growth  of 
certain  diseases  which  develop  unnoticed  from 
their  start;  and  second,  preserving  by  rules  of 
hygiene  appropriate  to  each  case  those  organs 


May,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


213 


subject  to  unhealthy  tendencies  either  hereditary 
or  acquired.  That,  as  you  see,  covers  a multi- 
tude of  evils.  And  if  there  are  no  pathologic 
processes,  isn't  the  relief  of  mental  strain  worth 
a good  deal? 

I shall  not  go  into  details  concerning  what 
should  be  included  in  a routine  examination.  But 
I think  you  should  know  a bare  outline.  First 
of  all,  you  should  tell  your  physician  the  whole 
story  of  your  daily  habits  and  diet  and  any  symp- 
toms of  mal-function  or  disease.  Then  you  should 
have  all  the  organs  of  the  body  carefully  ex- 
amined. Laboratory  work  should  include  a blood 
count  for  anemia  or  other  blood  dyscrasia,  a 
Wasserman  test,  and  a urinalysis.  The  X-ray  ex- 
amination if  indicated  should  be  made.  Blood 
chemistry  tests,  a sputum  examination,  and  other 
examinations  should  be  done  as  necessary.  We 
cannot,  however,  stop  here.  Treatment  with  cor- 
rection of  defects  as  indicated  is  essential  to 
success  of  the  plan. 

Since  the  onset  of  the  depression  people  are 
recognizing  more  fully  the  value  of  good  health 
in  assuring  a good  wage  earning  capacity.  Why 
cannot  we  recognize  the  importance  of  a heal- 
thy home  maker?  Think  of  the  social  gains  and 
the  benefits  in  health  and  in  joy  of  living  which 
would  result  from  health  protection  of  women 
who  are  too  often  careless  of  their  own  welfare 
even  though  they  insist  upon  health  care  of  their 
families. 

<*> 

ADVANCES  IN  OVARIAN  THERAPY. 


A gynecologist,  whose  name  is  known  from  coast  to 
coast,  recently  commented  in  the  Journal  of  the  Ameri- 
can Medical  Association  (Feb.  23rd)  about  the  cost  of 
ovarian  therapy:  "It  is  greatly  regretted,  he  wrote,  "that 
the  American  products  have  not  been  available  at  prices 
that  justify  their  preference  or  at  least  their  being  on  a 
parity  with  the  imported  material." 

Physicians,  who  have  read  this  statement,  will  be  inter- 
ested in  the  announcement  from  the  Squibb  Laboratories 
that  the  potency  of  Amniotin — a physiologically  tested 
preparation  of  the  ovarian  follicular  hormone,  has  been 
increased  three-fold  and  the  cost  per  unit  has  been  re- 
duced to  about  one-tenth  of  its  former  price.  For  hypo- 
dermic administration,  Amniotin  in  Oil  is  now  distributed 
in  I cc.  size  ampuls  containing  8,000  and  2,000  Interna- 
tional Units  per  cc. 

Amniotin  Capsules  and  Pessaries  (vaginal  supposito 
ries)  now  contain  1,000  and  2,000  International  Units,  re- 
spectively. The  price  of  these  packages  is  now  so  low  as 
to  compare  favorably  with  the  cost  of  insulin. 

These  new  high-potency  preparations  should  make  ovar- 
ian hormone  (estrin)  therapy  eminently  more  satisfactory. 
Amniotin  is  indicated  in  the  treatment  of  menopausal 
symptoms;  involutional  melancholia:  gonorrheal  vaginitis 
in  children;  senile  vaginitis;  breast  hyperplasia  (lobular 
type  associated  with  bleeding);  selected  cases  of  frigidity, 
and  migrain  of  pituitary  origin. 


LATE  SYPHILIS* 

S.  F.  HOGE,  M.  D. 
Little  Rock 


It  is  somewhat  of  a challenge  when  we  con- 
sider that  we  have  studied,  recognized  and  treat- 
ed spyhilis  for  nearly  five  centuries,  but  that  we 
have  neither  stopped  its  spread  nor  rid  our  hos- 
pitals for  nervous  diseases  of  these  unfortunate 
patients.  Syphilis,  because  of  its  great  preval- 
ence, marked  vicissitudes,  inherent  ability  to  at- 
tack and  destroy  any  and  every  type  of  body 
tissue,  belongs  to  the  major  medical  problems. 
So  much  is  already  known  relative  to  the  familiar 
clinical  entity,  syphilis  or  lues,  that  one  almost 
hesitates  to  present  the  subject,  lest  it  prove  to 
be  a rehash  of  the  data  already  presented  in 
so  masterly  a manner,  adding  little  or  nothing 
to  our  present  store  of  knowledge. 

It  is  firmly  established  that  the  treponema  pal- 
lida, isolated  and  identified  by  Schaudinn  (I), 
in  1905,  is  the  essential  causative  factor  of  every 
evident  manifestation  of  the  disease.  The  histo- 
pathological  changes  are  familiar  to  the  alert 
pathologist  and,  except  in  very  few  instances, 
will  support  a positive  statement  relative  to  its 
presence  or  absence.  When  Ehrlich  announced 
the  spirocheticidal  action  of  certain  arsenical 
combinations  in  1910,  it  was  hoped  and  believed 
that  this  type  of  ammunition  would  bombard  the 
spiral  organism  out  of  its  every  stronghold. 
Would  a frank  audit  of  our  present  data,  with 
a cold  scientific  analysis  of  the  results,  tend  to- 
ward optimism  or  incline  our  thoughts  along  lines 
of  further  research  which  bid  fair  to  be  far  more 
fruitful  than  those  already  conquered? 

If  we  are  to  accept  the  references  made  in 
the  Chinese  medical  literature  during  the  Ming 
dynasty,  they  were  treating  syphilis  more  than 
five  and  one-half  centuries  ago,  and  they  were 
familiar  with  gonorrhea  about  3000  B.  C.  The 
study  of  bone  lesions  of  the  Astec  Indians  of 
Central  and  South  American  countries  suggest 
a very  ancient  prevalence  of  this  disease.  The 
European  countries  were  scourged  by  this  plague 
in  the  latter  part  of  the  fifteenth  and  early  part 
of  the  sixteenth  centuries.  It  ranks  second  only 
to  "Black  Death,"  which  swept  away  one-fourth 
the  population  of  the  earth  at  that  time  (over 
sixty  million  human  beings)  and  has  been  known 
as  the  "King  of  Terrors."  The  syphilitic  plague 
appeared  about  the  time  of  the  siege  of  Naples 

* Read  before  the  Fifty-ninth  Annual  Session  of  the 
Arkansas  Medical  Society,  held  in  Little  Rock,  April 
16-18,  1934. 


214 


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[Vol.  XXXI,  No.  12 


in  1495.  Whether  or  not  Columbus  sailed  with- 
out it  and  returned  a victim  of  the  torch  of  the 
shrine  of  Venus,  remains  a quandry.  We  know 
that  shortly  after  his  return  epidemic  syphilis 
swept  the  country,  visiting  peasant,  soldier,  rul- 
ing class  and  all,  alike.  From  that  time  on  to 
the  present,  nothing  has  checked  its  riotous  de- 
vastation. Being  a social  veneral  disease,  its 
legal  restraint  by  law  or  order  becomes  next  to 
impossible. 

At  present,  syphilis  is,  in  some  respects,  less 
obviously  malignant  than  formerly;  the  terrible 
bone  lesions  are  now  rarely  seen  except  in  mu- 
seums. It  might  be  inferred  thaf  fhis  is  due  to 
treatment  but  improvement  began  long  before 
the  introduction  of  salvarsan,  bismuth  or  silver. 
The  question  of  greater  racial  resistance  looms 
strong  on  the  horizon  of  improvement.  The 
newer  methods  of  treatment  have  greatly  short- 
ened the  duration  of  the  infective  period  (an 
accomplishment  to  be  proud  of  which  may  in 
time  pave  the  way  to  the  elimination  of  this 
scourge),  but  their  influence  on  the  late  nerv- 
ous and  vascular  lesions,  tabes,  general  paraly- 
sis, aneurysm,  cardiac  disease,  cannot  be  finally 
estimated  at  this  time.  Some  statistics  (2),  sug- 
gest that  unless  they  produce  complete  steriliza- 
tion rapidly  the  arseno-benzol  preparations  may 
damage  the  immunity  mechanism.  This  is  strong- 
ly suggested  by  the  increased  frequency  of 
aortitis,  aneurism  and  myocarditis  (3),  tabes  and 
general  paralysis. 

To  enhance  our  knowledge  of  the  clinical  man- 
ifestations, and  to  emphasize  the  optimum  time 
for  prevention  and  therapeusis,  we  have  the 
three,  and  possibly  four,  stages  of  the  disease; 
the  primary,  or  stage  of  the  chancre,  the  sec- 
ondary, or  stage  of  eruption,  and  the  tertiary, 
or  stage  of  the  gumma.  The  fourth  phase  is 
manifested  in  such  clinical  entities  as  tabes  dor- 
salis and  general  paralysis.  It  is  with  this  phase 
that  this  paper  is  particularly  interested,  and  we 
wish  to  present  our  data,  hoping  to  prove  a vis 
a tergo  to  our  interest  in  prevention  and  inten- 
sification of  treatment  during  the  infective  stage. 

Peterson  (4)  states  that  a graphic  plot  of  the 
incidence  of  syphilis  shows  35  per  cent  of  the 
population  of  the  southern  states  to  be  involved, 
and  that  as  we  proceed  north  the  incidence  falls 
to  about  10  per  cent,  while  the  incidence  of 
tabes  and  paresis  is  just  the  reverse.  Cole, 
Moore,  O'Leary  et  al,  (5),  following  a most  care- 
ful and  thorough  study  of  late  or  latent  syphilis, 
developed  some  very  interesting  data  that 
should  again  emphasize  the  importance  of  pre- 


vention and  early  intensive  treatment.  "The 
probable  outcome  of  untreated  latent  syphilis, 
assuming  that  the  disease  has  existed  at  least 
four  years,  so  that  the  patient's  own  defense 
mechanism  has  had  sufficient  time  to  become 
firmly  established,  a searching  physical  examina- 
tion having  revealed  no  lesions,  especially  of  the 
cardio-vascular  or  central  nervous  system,  and 
that  the  cerebro-spinal  fluid  is  negative;  one  is 
probably  justified  in  predicting  that  a given  pa- 
tient, if  he  receives  no  treatment  at  all,  has  about 
two  chances  in  ten  of  developing  any  serious 
trouble,  at  worst  no  more  than  three  chances 
in  ten.  If  lesions  do  occur,  there  is  probably 
no  more  than  an  even  chance  that  they  will  be 
incapacitating.  Cardio-vascular  involvement  is 
the  great  risk  which  must  be  feared.  Dealing 
with  the  prognostic  value  of  a negative  spinal 
fluid  in  late  syphilis,  the  danger  of  development 
of  neuro-syphilis  (probably  excepting  only  a more 
or  less  purely  vascular  involvement)  is  largely 
passed  by  the  time  true  latency  is  achieved.  Fur- 
thermore, if  no  evidence  of  cardio-vascular  in- 
volvement can  be  found  on  the  basis  of  symp- 
toms, physical  signs  or  X-ray  at  the  original  ex- 
amination of  the  patient  with  late  syphilis,  one 
may  hazard  the  additional  prognostic  guess  that 
even  if  clinical  evidence  of  this  type  of  involve- 
ment does  ultimately  appear,  it  will  probably 
only  occur  after  ten  or  more  years." 

In  addition  to  all  that  has  been  studied  and 
tried,  and  cognizant  that  the  topographic  map 
of  tabetic  and  paretic  prevalence  of  the  United 
States  parallels  the  storm  tracks,  our  southern 
hospitals  for  nervous  diseases  carry  about  14  to 
15  per  cent  of  patients  who  are  suffering  from 
a disease  contracted  not  "in  line  of  duty."  The 
data  presented  is  a study  of  42  cases  as  com- 
piled by  O'Neil  and  Wright  (6),  and  60  cases 
of  our  own  observation  carried  out  along  parallel 
lines,  making  in  all  102  cases  of  general  paraly- 
sis. Only  the  final  summaries  will  be  given  as 
a detailed  report  would  be  cumbersome  and  of 
interest  to  but  a small  majority.  The  average 
age  of  the  patients  in  this  series  is  40  years.  The 
average  time  elapsing  from  the  history  of  chancre 
to  admission  to  the  hospital  is  156.5  months.  The 
average  time  from  onset  of  mental  symptoms  to 
hospitalization  is  60.7  months.  The  average  time 
from  appearance  of  chancre  to  onset  of  mental 
disease  is  78.5  months.  The  death  rate  is  ap- 
proximately 16  per  cent,  based  on  the  records 
of  a six-year  period.  The  percent  of  patients 
discharged  from  the  hospital  during  the  same 
period  and  classed  as  improved  is  27  per  cent, 


May,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


215 


having  57  per  cent  still  on  our  hospital  service, 
of  which  about  80  per  cent  are  on  closed  wards. 
At  first  glance,  not  a very  encouraging  result, 
but  when  we  compare  the  present  percentages 
with  those  of  several  years  passed  and  consider 
the  difference  in  the  physical  status  of  our  pa- 
tients, we  may  rightfully  assume  a more  opto- 
mistic  attitude  in  the  handling  of  what  were  con- 
sidered hopeless  cases.  The  number  of  months 
spent  in  the  hospital  by  the  group  of  60  patients 
during  the  six  years  is  3,363.  The  financial  bur- 
den at  the  rate  of  $4.74  per  hospital  day  at 
once  becomes  evident. 

The  treatment  given  covers  the  usual  familiar 
drugs  continued  over  long  periods  of  time  and 
in  full  dosage.  The  60  patients  received  6,420 
doses  of  tryparsamide  while  in  the  hospital.  The 
largest  number  administered  to  a single  patient 
was  268  doses.  346  grams  of  salvarsan  was  used, 
one  patient  receiving  71.1  grams.  Neosalvarsan 
was  more  freely  given,  887  grams  being  used, 
76.5  grams  being  given  to  one  patient.  Only 
a limited  amount  of  sulpharsphenamin  was  used. 
Salicylate  of  mercury  ranks  next  to  tryparsamide 
in  the  number  of  doses,  2,343  doses  of  1-6  grain 
each  being  administered.  The  largest  amount 
given  to  one  patient  was  108  doses,  or  18  grains 
of  salicylate  of  mercury.  The  usual  mixed  treat- 
ment of  mercury  and  iodides  by  mouth,  was  not 
freely  used  as  the  results  did  not  seem  to  war- 
rant. 

Malarial  treatment  was  used  on  44  patients 
in  our  series  of  60,  and  on  all  in  the  series  re- 
ported by  Wright  and  O'Neil.  The  highest  tem- 
perature reached  by  any  of  our  patients  was 
107  degrees.  The  longest  series  of  chills  was 
17  in  our  series  and  21  in  Wright  and  O'Neil's. 
The  I ongest  continuous  temperature  was  58 
hours.  The  largest  number  of  repeated  inocula- 
tions was  4.  The  results  of  our  studies  are  re- 
corded as  follows:  No  remarks  7,  no  improvement 
18,  about  the  same  10,  aggravated  2,  and  im- 


proved 7. 

TABLE  I 

Average  age  of  patients  observed 40  Yrs. 

Average  time  spent  in  hospital  56  Mos. 

Average  time  from  stage  of  chancre  to 

hospitalization  - - - - 156.5  Mos. 

Average  time  from  stage  of  chancre  to 

mental  symptoms  78.5  Mos. 

Average  time  from  appearance  of  men- 
tal symptoms  to  hospitalization  60.7  Mos. 

Death  rate,  approximately  ....  16  % 

Patients  discharged  as  improved  27  % 

Patients  remaining  in  hospital  57  % 

Patients  remaining  on  closed  wards  80  % 


TABLE  II 

Total  amount  of  tryparsamide  used  6,420  grams 

Largest  quantity  to  one  patient  450  grams 

Total  amount  of  salvarsan  . 346  grams 

Largest  quantity  to  one  patient  71.1  grams 

Total  amount  of  neosalvarsan  887  grams 

Largest  quantity  to  one  patient  76.5  grams 

Total  amount  of  mercury  salicylate 390.5  grains 

Largest  quantity  to  one  patient  18  grains 

TABLE  III 

Number  of  patients  receiving  malarial 

therapy  44 

Highest  temperature  ....  1 07  degrees 

Longest  series  of  chills  17 

Longest  continuous  temperature  58  hours 

Longest  number  of  repeated  inoculations 4 

Results:  No  remarks  7 

No  improvement  18 

About  same  10 

Aggravated  2 

Improved  7 


The  serologic  studies  show  general  improve- 
ment. The  Wasserman  showed  a definite  ten- 
dency to  gravitate  to  a negative  reading.  The 
gold  curve  changed  from  the  typical  paretic 
picture  through  the  tabetic,  to  one  not  diagnos- 
tic of  either  condition  and  essentially  negative. 
The  cell  count  and  globulin  parallel  the  findings 
of  the  Wasserman  and  gold  curve.  The  sero- 
logic studies  indicate  that  these  patients  should 
be  well  along  on  the  way  to  complete  eradica- 
tion of  the  disease,  but  the  clinical  picture  leaves 
much  to  be  desired. 

In  summing  up  the  results  of  this  series  of  102 
paretics,  optomism  runs  at  low  ebb.  From  the 
therapeutic  and  serologic  standpoint  definite  im- 
provement is  evident,  but  from  the  clinical  sta- 
tus much  is  yet  desired.  From  the  progress  of 
our  medical  therapy  much  has  been  attempted; 
something  has  been  accomplished,  but  the  goal 
of  successful  treatment  is  still  a long  way  off. 
The  prevention  of  these  states  offers  an  excel- 
lent opportunity  for  improvement  of  our  results. 
This  again  shows  how  vitally  important  it  is  to 
prevent  the  dissemination  of  the  disease  and  to 
vigorously  press  the  early  treatment,  lessening  the 
incidence  of  the  late  and  more  or  less  hopeless 
phases  of  syphilis. 

BIBLIOGRAPHY 

( I ).  Schaudinn.  Arb.  a.  d.  w.  Gesundhst.,  22,  1905. 

(2) .  Gager.  Clinical  Excerpts,  1934. 

(3) .  Warthin.  Southern  Medical  Journal,  1929-30. 

(4) .  Peterson,  Journal  Syphilis  and  Neurology,  Jan. 
1934,  Page  75. 

(5) .  Cole,  Moore,  Oleary.  U.  S.  P.  H.  Service,  Sept. 
20,  1932.  Special  article  No.  2. 

(6) .  O'Neil  and  Wright.  Journal  Syphilis  and  Neu- 
rology, Jan.,  1934. 


216 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  12 


DISCUSSION 

T.  M.  Fly,  Little  Rock:  I don't  think  there  is  any  ex- 

cuse to  give  any  sick  or  well  person  or  any  other  kind  of 
person,  178  shots  of  anything.  Another  thing,  we  don't 
remember  what  we  see  or  hear  outside  of  our  medical 
books. 

I remember  many  years  ago  reading  where  Benvenuto 
Cellini  described  his  own  case  as  French  disease.  He 
went  to  the  doctors,  and  they  put  him  on  mercury  and 
other  metals.  And  he  grew  progressively  worse  and  he 
quit,  and  then  he  began  to  take  the  wood,  as  they  called 
it,  meaning  guaiac.  He  used  it  with  benefit  for  two  or 
three  months,  and  thought  he  was  well,  and  after  stopping 
its  use  the  disease  developed  again;  and  he  went  back 
to  the  doctors  and  they  put  him  on  the  metals  again, 
and  he  grew  worse  and  worse,  so  much  worse  that  he 
couldn't  get  out  of  bed.  So  he  went  to  the  doctors  no 
more  but  took  to  the  wood  again,  using  it  for  a period 
of  some  two  or  three  months,  and  never  took  any  further 
treatment.  He  was  evidently  completely  cured  for  he 
lived  to  be  a man  of  70  or  more  years,  apparently  well, 
and  what  a stormy  life  he  lived!  He  was  a man  far 
above  the  average  in  intelligence,  and  his  statements 
are  worth  believing.  So,  I have  had  occasion  to  try 
that  drug  on  several  cases  where  the  metals  failed  to 
cause  improvement,  and  those  cases  were  always  bene- 
fited. 

This  may  be  worth  something  to  you  who  treat  syphilis. 
I think  it  is  well  worth  trying. 

<*> 

SODIUM  THIOCYANATE  AS  A PRO- 
PHYLAXIS AND  IN  THE  TREATMENT 
OF  BACILLARY  DYSENTERY  WITH 
SPECIAL  EMPHASIS  UPON  THE 
SHIGA  TYPE* 

L.  D.  MASSEY,  M.  D. 

Osceola 


During  May,  1933,  there  developed  in  the  Os- 
ceola territory  an  acute  epidemic  of  the  com- 
monly-termed "bowel  complaint."  Patients  had 
intense  pain,  numerous  stools  with  mucous  and 
blood,  marked  dehydration,  acute  starvation, 
with  death  occurring  in  from  3 to  7 days  after 
onset. 

Shiga  bacilli  were  isolated  from  the  colonic 
contents  after  autopsy  on  a child,  whose  death 
was  the  second  in  that  family.  With  this  in- 
formation and  additional  data  supplied  by  Dr. 
E.  C.  Mitchell  of  the  experimental  work  of  Ivy 
of  Northwestern  University  on  Shiga  bacillus  dys- 
sentery  by  sodium  thiocyanate,  the  decision  was 
made  to  treat  all  future  cases  in  this  manner. 
Routine  treatment  with  fluids,  diet,  preservation 
of  the  patient's  strength,  the  use  of  opium,  and 
blood  transfusions  were  continued. 

In  a series  of  15  cases,  9 of  whom  were  given 

* Abstract  of  a paper  read  before  the  First  Councilor 
District  Medical  Society  at  Jonesboro,  October  24.  1934. 


sodium  thiocyanate  immediately,  it  was  noted 
that  the  stools  diminished  in  from  24  to  72  hours, 
that  toxicity  disappeared,  that  cultures  from  the 
stools  became  negative,  and  that  the  patients  re- 
covered. Five  patients  in  this  series,  who  were  not 
treated  with  sodium  thiocyanate  due  to  inability 
to  obtain  the  drug,  died.  One  case  receiving  so- 
dium thiocyanate  died.  During  1933,  39  cases 
were  given  sodium  thiocyanate.  The  drug  was 
given  by  mouth  to  all  families  where  positive  cul- 
tures were  found  as  a prophylactic  measure.  Ex- 
tra sanitary  and  food-handling  precautions  were 
carried  out,  and  no  further  cases  occurred  in 
these  families.  No  toxicity  was  observed  to  the 
drug. 

The  following  routine  was  adopted: 

Sodium  thiocyanate  given  in  20  mgm.  per  kilo- 
gram of  body  weight  intravenously  when  the  case 
was  first  seen.  The  daily  dose  did  not  exceed 
one  gram.  If  no  improvement  occurred,  the  in- 
travenous injections  were  continued  for  three 
successive  days,  never  longer.  In  addition,  rec- 
ognized treatment  as  maintenance  of  fluid  bal- 
ance, blood  transfusions,  opium,  proper  diet, 
were  carried  out.  No  other  treatment  was  em- 
ployed. 

Summary: 

Seventy-three  cases  of  bacillary  dysentery 
(Shiga)  are  reported  who  were  given  20  mgm. 
per  kilogram  of  body  weight  doses  of  sodium 
thiocyanate.  Some  were  given  one  dose;  others, 
as  many  as  three  successive  doses,  depending 
upon  the  clinical  manifestations  following  the  first 
dose.  In  addition,  as  a prophylactic  measure,  all 
persons  in  direct  contact  with  the  case  were 
given  1-3  grain  of  the  drug,  in  broken  doses,  for 
each  kilogram  of  body  weight  daily  for  three 
successive  days.  In  several  cases  where  there 
was  a history  of  contact  and  the  individual  pre- 
sented slight  symptoms,  the  drug  was  used  intra- 
venously in  the  same  dosage  as  recommended 
for  treatment. 

The  mortality  for  all  patients  who  were  given 
the  drug  was  13.7  per  cent. 

€> 

Publisher's  Statement  of  Circulation 

As  required  by  the  Code  Authority  for  Periodical  Pub- 
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This  is  to  certify  that  the  average  circulation  per  issue 
of  The  Journal  of  the  Arkansas  Medical  Society  for  the 
six  month's  period  July  1st  to  and  including  December 
31st,  1934,  was  as  follows:  1290  copies. 

The  Journal  of  the  Arkansas  Medical  Society, 

By  W.  R.  Brooksher,  Editor. 

Subscribed  to  and  sworn  before  me  on  this  23rd  day 
of  March,  1935.  Neil  Sims,  Notary  Public.  My  commis- 
sion expires  Feb.  20,  1938. 


May,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


217 


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610  First  National  Bank  Bldg.,  Fort  Smith,  Arkansas 


The  advertising  policy  of  this  Journal  is  governed  by  the  rules 
of  the  Council  on  Pharmacy  and  Chemistry  of  the  American 
Medical  Association. 

All  communications  to  this  Journal  must  be  made  to  it  exclu- 
sively. Communications  and  items  of  general  interest  to  the  pro- 
fession are  invited  from  all  over  the  State.  Notice  of  deaths, 
removals  from  the  State,  changes  of  location,  etc.,  are  requested. 


OFFICERS  OF  THE  ARKANSAS  MEDICAL  SOCIETY 


M.  E.  McCASKILL,  President Little  Rock 

GEO.  B.  FLETCHER,  President-Elect  Hot  Springs 

D.  W.  GOLDSTEIN,  First  Vice-President  Fort  Smith 

J.  B.  JAMESON,  Second  Vice-President  Camden 

H.  W.  HUNDLING,  Third  Vice-President  Little  Rock 

R.  J.  CALCOTE,  Treasurer  Little  Rock 

W.  R.  BROOKSHER,  Secretary Fort  Smith 


COUNCILORS 

First  District — H.  A.  STROUD  Jonesboro 

Second  District — M.  C.  HAWKINS,  JR.  Searcy 

Third  District — F.  A.  CORN,  JR.  Lonoke 

Fourth  District — C.  W.  DIXON  Gould 

Fifth  District — L.  L.  PURIFOY  El  Dorado 

Sixth  District — DON  StvIlTH Hope 

Seventh  District — J.  M.  PROCTOR  Hot  Springs 

Eighth  District — S.  B.  HINKLE  Little  Rock 

Ninth  District — D.  L.  OWENS  Harrison 

Tenth  District — S.  J.  WOLFERMANN  ....  Fort  Smith 


EDITORIAL 


THE  FORT  SMITH  MEETING 

Total  registration  for  the  Sixtieth  Annual  Ses- 
sion held  in  Fort  Smith  April  I 5- 1 7th  was  356,  of 
whom  317  were  Arkansas  physicians,  a remark- 
able registration  for  a convention  city  not  more 
centrally  located.  The  Sebastian  County  Med- 
ical Society  fulfilled  its  every  promise  for  a 
meeting  of  profit  and  enjoyment  to  all  who  vis- 
ited the  border  city.  As  was  to  be  expected,  the 
social  features  of  the  meeting  were  most  pleas- 
ing. The  second  evening's  entertainment  sur- 
passed even  that  of  1930  when  this  same  host  so- 
ciety introduced  the  buffet  supper,  dance  and 
entertainment  evening  feature  as  a social  event 
of  the  state  meeting.  Introduced  as  another  in- 
novation by  the  host  society  this  year  was  the 
mass  open  house  party  for  all  visitors.  This  con- 
tributed greatly  in  the  friendliness  of  the  ses- 
sion, permitting  the  renewal  of  old  acquaintance- 
ships and  the  formation  of  new  ones  most  leis- 
urely in  the  homes  of  Fort  Smith  physicians. 

The  scientific  program  was  distinguished  by 
the  excellence  of  its  presentations  and  drew  an 
attendance  each  day  in  excess  of  the  average. 
Outstanding  were  the  papers  of  the  distinguished 
guests  who  were:  Walter  L.  Bierring,  President  of 


the  American  Medical  Association,  making  the 
first  official  visit  of  a national  president  to  an 
Arkansas  meeting;  Sam  E.  Thompson,  President, 
Texas  State  Medical  Association;  Eugene  Rosa- 
mond, Memphis;  Lucian  Landry,  New  Orleans; 
Paul  A.  O'Leary,  Rochester;  Ralph  Bowen,  Okla- 
homa City;  G.  V.  Brindley,  Temple,  Texas;  and 
Ralph  A.  Reis,  Chicago.  Members  of  the  Ark- 
ansas Medical  Society  presented  an  unusually 
well-grouped  arrangement  of  able  and  thought- 
ful papers  which  provoked  free  discussion. 

The  House  of  Delegates  unanimously  voted 
for  a return  to  the  constitutional  assessment  of 
five  dollars  yearly  from  members  thus  relieving 
the  officers  and  councilors  of  apprehension  as  to 
proper  and  efficient  operation  of  the  Society 
due  to  the  greatly  curtailed  income  of  the  past 
three  years. 

The  formation  of  a special  section  in  the  So- 
ciety for.Opthalmology  and  Otolaryngology  was 
approved  and  this  section  was  organized  with  the 
following  officers:  H.  Moulton,  Fort  Smi  th,  Chair- 
man, and  L.  M.  Henry,  Fort  Smith,  Secretary.  A 
resolution  approving  the  action  of  the  special 
session  of  the  House  of  Delegates  of  the  Ameri- 
can Medical  Association  held  in  February,  1935, 
and  calling  on  Arkansas  representatives  in  the 
national  Congress  to  oppose  by  every  practical 
means  all  measures  which  may  be  proposed  for 
the  control  of  the  practice  of  medicine  which  are 
inimical  to  the  best  interests  of  medicine  an  d of 
the  people,  was  unanimously  adopted. 

Officers  elected  for  1935-36  were:  President- 
elect, George  B.  Fletcher,  Hot  Springs  National 
Park;  1st  Vice-president,  D.  W.  Goldstein,  Fort 
Smith;  2nd  Vice-president,  J.  B.  Jameson,  Cam- 
den; 3rd  Vice-president,  H.  W.  Hundling,  Little 
Rock;  Treasurer,  R.  J.  Calcote,  Little  Rock;  Sec- 
retary, W.  R.  Brooksher;  Delegate  to  the  Amer- 
ican Medical  Association,  W.  R.  Brooksher,  Fort 
Smith;  Alternate,  F.  O.  Mahony,  El  Dorado.  The 
Council  with  new  and  hold-over  members  is  now 
composed  of  the  following:  1st  District,  H.  A. 
Stroud,  Jonesboro;  2nd  District,  M.  C.  Hawkins, 
Jr.,  Searcy;  3rd  District,  F.  A.  Corn,  Jr.,  Lonoke; 
4th  District,  C.  W.  Dixon,  Gould;  5th  District,  L. 
L.  Purifoy,  El  Dorado;  6th  District,  Don  Smith, 
Hope;  7th  District,  J.  M.  Proctor,  Hot  Springs 
National  Park;  8th  District,  S.  B.  Hinkle,  Little 
Rock;  9th  District,  D.  L.  Owens,  Harrison;  and 
10th  District,  S.  J.  Wolfermann,  Fort  Smith.  At 
the  organization  meeting  of  the  new  Council  S. 
J.  Wolfermann  and  D.  L.  Owens  were  re-elected 
President  and  Secretary,  respectively,  of  that 
body,  and  W.  R.  Brooksher  was  re-elected  Editor. 


218 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  12 


PROCEEDINGS  OF  SOCIETIES 


The  Third  Councilor  District  Medical  Society 
met  at  DeVall's  Bluff  April  5th  for  the  following 
scientific  program: 

"Diagnosis  and  treatment  of  gonorrhea  and 
its  complications" — Russell  Hennessey,  Mem- 
phis. 

"Points  and  treatment  of  fractures  of  interest 
to  the  general  practitioner" — F.  W.  Carruth- 
ers,  Little  Rock. 

"The  cancer  problem" — Dewell  Gann,  Jr., 
Little  Rock. 

"Signs  and  symptoms  of  the  acute  surgical  ab- 
domen, usually  first  seen  by  the  general  prac- 
titioner"— E.  M.  Holder,  Memphis. 

'Considering  the  possibilities  in  diagnosis"— 
O.  C.  Melson,  Little  Rock. 

Following  the  scientific  session  a fish  dinner 
was  served  to  the  seventy-five  physicians  in  at- 
tendance. The  Society  will  next  meet  at  Wynne. 

The  Sebastian  County  Medical  Society  was  ad- 
dressed April  9th  by  G.  W.  Reagan,  Little  Rock, 
on  "Bladder  Neck  Obstructions." 


The  Fifth  Councilor  District  Medical  Society 
met  at  Magnolia  in  dinner  session  on  April  9th. 
The  following  program  was  presented: 

"The  Fracture  Problem" — F.  W.  Carruthers, 
Little  Rock. 

"Skin  Cancer" — G.  F.  Jackson,  Little  Rock. 
"Corneal  Ulcer," — R.  J.  Calcote,  Little  Rock. 


The  Fourth  Councilor  District  Medical  Society 
met  jointly  with  the  Jefferson  County  Medical 
Society  in  dinner  session  at  Pine  Bluff  during 
April  and  elected  the  following  officers:  Presi- 
dent, G.  C.  DeBolt,  Monticello;  Vice-president, 
M.  C.  Crandall,  Wilmot;  and  Secretary,  H.  T. 
Smith,  McGehee.  Dr.  Ray  M.  Balyeat,  Okla- 
homa City,  addressed  the  session  on  "Asthma." 

The  annual  banquet  session  of  Garland  County 
Medical  Society  was  held  April  9th  at  Hot 
Springs  National  Park.  Speakers  were:  F.  O. 
Mahony,  El  Dorado,  "The  Doctor's  Problems": 
Joe  Shuffield,  Little  Rock,  "Medical  Economics"; 
and  T.  N.  Black,  Hot  Springs  National  Park,  "The 
Veterans  Racket". 


The  Second  Councilor  District  Medical  Society 
met  jointly  with  the  Woman's  Auxiliary  in  ban- 
quet session  at  Batesville  April  8th.  The  follow- 


ing scientific  program  was  presented:  "Diag- 
nosis of  Heart  Failure,"  S.  C.  Fulmer,  Little 
Rock;  "Prophylaxis  of  Pyelitis  of  Pregnancy,"  E. 
H.  White,  Little  Rock;  and  "Occlusive  Arterial 
Disease  of  the  Extremities,"  F.  H.  Krock,  Fort 
Smith. 


OBITUARY 


WILLIAM  NOAH  ELKINS,  aged  51  years, 
died  at  his  home  in  Junction  City,  March  17th 
of  cardio-renal  disease.  He  was  a graduate  of 
the  University  of  Tennessee  College  of  Medicine 
in  1908  and  had  resided  in  Junction  City  for 
the  past  22  years.  He  was  a member  of  the 
Union  County  Medical  Society,  the  Arkansas 
Medical  Association  and  held  membership  in  the 
Masonic  and  Woodmen  of  the  World  lodges. 
He  is  survived  by  his  wife,  three  sons  and  one 
daughter. 


IMMUNIZE  NOW— STAMP  OUT 
DIPHTHERIA. 


May  Day — Child  Health  Day — has  become  an  estab- 
lished institution  throughout  the  United  States.  In  1928 
the  United  States  Congress  passed  a joint  resolution  des- 
ignating May  first  as  Child  Health  Day,  and  authorizing 
the  President  to  issue  a proclamation  requesting  national 
observance  of  the  day.  Child  Health  Day  celebrations 
are  intended  only  to  mark  and  emphasize  either  the  inau- 
guration or  the  culmination  of  year-round  work  for  im- 
provement of  the  health  of  children.  . The  project  for 
1935  is  diphtheria  immunization.  This  was  chosen  because 
there  has  been  but  little  reduction  since  1930  in  the  num- 
ber of  deaths  from  diphtheria  throughout  the  country. 

The  measures  proposed  are: 

To  immunize  all  children  between  the  ages  of  six 
months  and  six  years, 

To  make  early  immunization  a routine  practice 
by  all  physicians. 

The  majority  of  pediatricians  do  immunize  the  babies 
under  their  care  during  the  first  year  of  life.  Physicians 
in  general  practice  also  should  follow  this  procedure. 

State  Departments  of  Health  and  the  unofficial  organi- 
zations interested  in  children  are  calling  the  attention  of 
parents  and  communities  to  the  need  for  early  diphtheria 
immunization.  Each  individual  physician  should  be  pre- 
pared to  take  care  of  the  applications  for  immunization. 
Co-operative  plans  for  this  work  should  be  made  by  the 
local  medical  societies  and  departments  of  health  in  all 
communities.  When  a local  medical  society  has  perfected 
plans  for  this  phase  of  preventive  medicine,  there  is  no 
reason  why  it  would  not  be  possible  to  assume  gradually 
other  types  until  eventually  preventive  medicine  forms  an 
important  part  of  the  practice  of  all  physicians. 


May,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


219 


PERSONALS  AND  NEWS  ITEMS 


R.  T.  Henry  has  been  re-elected  school  director 
at  Springdale. 

J.  M.  Wallace  has  moved  from  Fayetteville 
to  Marshall. 


Drs.  R.  H.  Willett,  H.  H.  McAdams  and  E. 
R.  Barrett,  of  Jonesboro,  have  moved  into  their 
new  offices. 


Wm.  Johnson  has  been  elected  president  of 
the  Hardy  Chamber  of  Commerce. 

H.  H.  Smiley,  Texarkana,  has  been  appointed 
a member  of  the  state  welfare  board. 


"Eats,  Ether  and  Ethics"  was  the  subject  of 
a talk  by  Val  Parmley  before  the  Little  Rock 
Rotary  Club  March  28th. 

L.  R.  Brown,  Little  Rock,  addressed  the  public 
welfare  forum  of  the  Little  Rock  Foundation  of 
Women's  Clubs  March  28th  on  proposed  steri- 
lization of  habitual  criminals. 


"Undulant  Fever"  by  S.  C.  Fulmer,  Little  Rock, 
appeared  in  the  April  issue  of  The  Southern 
Medical  Journal. 


J.  D.  Mooney  has  been  elected  mayor  of  Coal 
Hill. 


Irving  J.  Spitzberg  has  been  elected  faculty 
advisor  of  the  Square  and  Compass  fraternity 
of  the  University  of  Arkansas  School  of  Medi- 
cine. 


Frank  Vinsonhaler  addressed  the  Army  Day 
banquet  of  the  Little  Rock  Chapter  of  the  Mili- 
tary Order  of  the  World  War  on  April  6th. 

J.  A.  Moore  has  been  elected  a member  of 
the  El  Dorado  Civil  Service  Commission. 


O.  C.  Wenger,  Hot  Springs  National  Park, 
addressed  an  open  meeting  of  the  Saint  Louis 
Medical  Society  April  9th  on  "Venereal  Disease 
as  a Public  Health  Problem." 


Fount  Richardson,  Fayetteville,  addressed  the 
Benton  County  Medical  Society  April  Nth  on 
the  district  health  unit  to  be  composed  of  Ben- 
ton, Crawford  and  Washington  counties. 


L.  L.  Hubener,  Little  Rock,  has  been  appointed 
resident  physician  for  the  ERA  colony  at  Dyess. 

A hospital  and  office  building  is  under  con- 
struction at  Harrison,  to  be  occupied  on  com- 
pletion by  Drs.  D.  L.  Owens,  J.  G.  Gladden  and 
W.  H.  Poynor. 

Drs.  N.  D.  Buie  and  Thomas  Glass  of  the  Buie 
Clinic  of  Marlin,  Texas,  were  guests  of  the  Acad- 
emy of  Medicine  of  Hot  Springs  National  Park 
April  2nd  for  luncheon.  The  subject  of  discus- 
sion was  "Hypertension." 

W.  G.  Hodges,  Malvern,  has  been  appointed 
a member  of  the  Hot  Spring  County  Welfare 
Board. 


Recent  appointments  as  city  health  officers 
are:  J.  Y.  Powell,  at  Gravette,  and  J.  P.  Baker, 
at  West  Helena. 


A.  C.  Kolb,  Hope,  has  been  elected  superin- 
tendent of  the  State  Hospital  for  Nervous  Dis- 
eases. 

3> 

AMERICAN  MEDICAL  GOLFERS  PLAY  IN  ATLANTIC 
CITY,  MONDAY,  JUNE  I0TH 


The  American  Medical  Golfing  Association  will  hold 
its  twenty-first  annnal  tournament  at  the  Northfield  Coun- 
try Club  in  Atlantic  City  on  Monday,  June  10,  1935. 

Thirty-six  holes  of  golf  will  be  played  in  competition 
for  the  seventy  trophies  and  prizes  in  the  nine  events. 
Trophies  will  be  awarded  for  the  Association  Champion- 
ship, thirty-six  holes  gross,  the  Will  Walter  Trophy;  the 
Association  Handicap  Championship,  thirty-six  holes  net, 
the  Detroit  Trophy;  the  Championship  Flight,  First  Gross, 
thirty-six  holes,  the  St.  Louis  Trophy;  the  Championship 
Flight,  First  Net,  thirty-six  holes,  the  President's  Trophy; 
the  eighteen  hole  championship,  the  Golden  State  tro- 
phy; the  eighteen  hole  handicap  championship,  the  Ben 
Thomas  trophy;  the  maturity  event,  limited  to  fellows 
over  60  years  of  age,  the  Minneapolis  trophy;  the  old- 
guard  championship,  limited  to  competition  of  past 
presidents,  the  Wendell  Phillips  trophy,  and  the  kickers 
handicap,  the  Wisconsin  trophy.  Other  events  and  prizes 
will  be  announced  at  the  first  tee. 

<5> 

THE  TRUE  ECONOMY  OF  DEXTRI-MALTOSE. 


It  is  interesting  to  note  that  a fair  average  of  the 
length  of  time  an  infant  receives  Dextri-Maltose  is  five 
months:  That  these  five  months  are  the  most  critical  of 
the  baby's  life:  That  the  difference  in  cost  to  the  mother 
between  Dextri-Maltose  and  the  very  cheapest  carbohy- 
drate, at  most  is  only  $6  for  this  entire  period — a few 
cents  a day:  That,  in  the  end,  it  costs  the  mother  less  to 
employ  regular  medical  attendance  for  her  baby  than  to 
attempt  to  do  her  own  feeding,  which  in  numerous  cases 
leads  to  a seriously  sick  baby  eventually  requiring  the 
most  costly  medical  attendance. 


220 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  12 


AUXILIARY  NEWS 


PRESIDENT'S  ADDRESS 

To  those  who  are  here  for  the  first  time  and  to  those 
who  have  given  years  of  service  to  this  organization,  I 
wish  to  express  my  sincere  thanks  and  appreciation  for 
the  honor  you  have  conferred  on  me. 

I shall,  to  the  best  of  my  ability,  endeavor  to  give  to 
you  the  service  such  an  organization  deserves.  I shall 
also  depend  much  upon  you  for  advice  and  co-operation 
in  all  things. 

As  a chain  is  no  stronger  than  its  weakest  link,  1 urge 
each  of  you  to  feel  that  it  is  your  personal  responsibility 
to  always  present  a solid  front  to  any  and  all  obstacles 
conflicting  with  the  aims  and  aspirations  of  our  society. 
I am  sorely  tempted  to  say  that  health  is  the  most  im- 
portant thing  in  the  world.  One  of  our  chief  objectives, 
that  of  Health  Education,  is  a grave  responsibility  and 
each  of  us  should  feel  it  a privilege  to  carry  her  share. 

Under  the  leadership  of  our  several  past  presidents,  the 
society  has  set  a standard  of  effort  and  accomplishment 
that  it  must  be  our  aim  to  equal  during  the  coming  year. 
Even  though  we  may  not  be  able  to  surpass  it,  I look 
forward  with  eagerness  and  confidence  to  the  privilege 
of  working  with  the  members  to  maintain  the  ideals  and 
carry  out  the  policies  of  the  society. 

A society  of  this  sort  has  two  aspects,  both  of  which 
are  of  great  importance.  First,  there  is  the  social  side 
of  our  work.  Many  woman's  auxiliaries  devote  themselves 
exclusively  to  the  social  objectives  and  seem  to  exist 
principally  to  bring  the  members  closer  together  in  a 
friendly  association.  This  should  not  be  underestimated 
because  it  is  a natural  and  necessary  part  of  the  activity 
of  any  organization  of  human  beings,  for  "man  is  a social 
animal"  and  all  of  his  aims  and  activities  run  better  and 
more  smoothly  when  they  are  carried  on  in  an  atmosphere 
of  good  fellowship  and  understanding. 

We  do  not,  however,  believe  that  social  meetings  should 
be  the  only  aim  and  end  of  an  organization  such  as  this. 
There  is  so  much  of  a serious  and  constructive  nature  that 
needs  to  be  done  in  connection  with  the  broader  work  of 
the  medical  profession  in  the  United  States.  The  woman's 
auxiliaries  are  placed  in  a unique  position  to  help  the 
profession  in  this  work.  First  of  all,  we  can,  by  our  atti- 
tude and  encouragement,  help  to  keep  the  ethical  stand- 
ards of  the  profession  on  the  high  plane  that  it  has  long 
occupied  in  our  country,  and  to  enhance  the  prestige  and 
confidence  that  it  enjoys.  To  do  this  it  is  important  to 
take  a stand  against  quackery  and  the  commercializing 
of  the  healing  art  that  constantly  springs  up  and  threat- 
ens the  integrity  of  the  whole  profession. 

By  quacks  and  quackery  we  do  not  mean  merely  the 
charlatan  and  the  doctor  who  violates  the  ethics  of  his 
profession,  but  also  the  indirect  and  insidious  methods 
used  to  foist  worthless  and  even  harmful  patent  cure-alls 
and  wonder-working  remedies  on  the  part  of  the  public 
which  is,  through  ignorance,  susceptible  to  the  deceptive 
claims  made  for  these  preparations.  At  this  time  a great 
effort  is  being  made  to  strengthen  and  broaden  the  pure 
food  and  drug  laws  of  this  country,  and  while  this  is  a 
much  needed  reform,  the  greatest  need  of  all  is  to  edu- 
cate the  people  so  they  will  be  able  to  discriminate  be- 
tween legitimate,  scientific  treatment  and  what  is,  after 
all,  simply  a modern  form  of  witch-doctoring. 

One  of  the  greatest  advances  in  the  work  of  protecting 
the  national  health  and  well-being  has  been  the  movement 
to  have  children's  clinics  and  examination  and  treatment 


of  pre-school  and  school  children.  This  is  a movement  in 
which  the  women's  auxiliaries  can  play  a most  valuable 
part  and  be  of  the  greatest  service  to  the  community  as 
well  as  the  profession  in  which  they  are  most  interested. 
The  conducting  of  health  surveys,  establishment  of  clinics 
and  education  of  the  careless  or  ignorant  part  of  the  pop- 
ulation saves  far  more  in  human  life  and  money  to  the 
community  and  the  state  than  the  outlay  necessary  for  its 
accomplishment. 

The  medical  profession  is  the  greatest  of  all  modern 
professions  in  a material  and  human  sense,  and  even  the 
Christian  ministry,  which  is  dedicated  to  the  soul  rather 
than  the  body,  is  making  more  and  more  use  of  the  heal- 
ing art  of  the  physician. 

Our  organization,  from  its  very  name,  is  intended  to  be 
an  aid  to  this  great  profession  and  we  can  not  do  too 
much  to  spread  the  benefits  and  blessings  of  its  work. 

(Mrs.  Marcus  T.)  JUSTINA  SMITH. 

A representative  audience  of  Texarkana  druggists'  wives 
as  guests  and  members  of  the  Bowie  and  Miller  Counties 
Medical  Auxiliaries  had  the  privilege  of  hearing  Mrs.  P. 
R.  Gilmer,  of  Shreveport,  Friday,  March  22nd,  when  she 
reviewed  "Men  of  Good  Will,"  by  Jules  Romains. , 

Mrs.  Gilmer  was  brought  to  Texarkana  by  the  Medical 
Auxiliary  for  a book  tea  that  took  place  at  the  McCartney 
Hotel.  Hostesses  for  the  afternoon  were  Mrs.  T.  E.  Fuller, 
Mrs.  Chas.  Adna  Smith,  Mrs.  Allen  Collom,  and  Mrs.  H. 
E.  Murry. 

Mrs.  B.  A.  Rhinehart  was  elected  president  of  the 
Woman's  Auxiliary  to  the  Pulaski  County  Medical  Society, 
at  a meeting  held  April  10th  at  the  home  of  Mrs.  W.  A. 
Snodgrass.  Other  officers  elected  were  Mrs.  R.  C.  Kory, 
president-elect;  Mrs.  J.  B.  Crawford,  first  vice  president; 
Mrs.  Bryce  Cummins,  second  vice  president;  Mrs.  Snod- 
grass, secretary;  Mrs.  M.  B.  Holmes,  publicity  secretary; 
Mrs.  Joe  F.  Shuffield,  treasurer;  Mrs.  Anderson  Watkins, 
historian,  and  Mrs.  R.  A.  Law,  parliamentarian.  The  fol- 
lowing delegates  were  elected  to  represent  the  Auxiliary 
at  the  annual  meeting  in  Fort  Smith:  Mrs.  Kory,  Mrs.  R. 
E.  Pryor,  Mrs.  E.  H.  White,  Mrs.  S.  C.  Fulmer,  Mrs.  Snod- 
grass and  Mrs.  A.  C.  Shipp.  Alternates  were  Mrs.  Bryce 
Cummins,  Mrs.  C.  C.  Reed,  Mrs.  W.  N.  Freemyer,  Mrs. 
M.  E.  McCaskill,  Mrs.  W.  L.  Sadler  and  Mrs.  Alvin  W. 
Strauss.  Board  members  to  attend  the  Medical  Auxiliary 
convention  will  be  Mrs.  Rhinehart,  Mrs.  Crawford,  Mrs. 
Watkins,  Mrs.  Byron  A.  Bennett,  and  M rs.  Charles  E.  Oates. 

Installation  of  new  officers  brought  to  a close  the  busi- 
ness sessions  of  the  eleventh  annual  convention  of  the 
Woman's  Auxiliary  to  the  Arkansas  Medical  Society,  April 
15-16-17. 

New  officers  elected  were; 

President — Mrs.  Marcus  T.  Smith,  Conway. 
President-Elect — Mrs.  J.  T.  McLain,  Gurdon. 

First  Vice-President — Mrs.  Pierre  Redman,  Fort  Smith. 
Second  Vice-President — Mrs.  Curtis  W.  Jones,  Benton. 
Third  Vice-President — Mrs.  H.  W.  Murry,  Texarkana. 
Fourth  Vice-President — Mrs.  A.  L.  Carter,  Berryville. 
Treasurer — Mrs.  B.  A.  Bennett,  Little  Rock. 

Publicity  Secretary — Mrs.  D.  W.  Goldstein,  Fort  Smith. 
Historian — Mrs.  C.  W.  Garrison,  Little  Rock. 
Parliamentarian — Mrs.  S.  A.  Collom,  Sr.,  Texarkana. 
Councilors — Mrs.  Wm.  Hibbitts,  Texarkana;  Mrs.  B.  A. 
Rhinehart,  Little  Rock;  Mrs.  P.  H.  Phillips,  Ashdown; 
Mrs.  Wm.  R.  Brooksher,  Jr.,  Fort  Smith;  Mrs.  Chas.  E. 
Oates,  Little  Rock. 


May,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


221 


INDEX 

JOURNAL  OF  THE  ARKANSAS  MEDICAL  SOCIETY 

VOLUME  XXXS 


JUNE,  1934 


Abbreviations:  Original  Article  (O);  Editorial  (E);  Abstract  (A): 
Obituary  (Ob);  Resolutions  (R);  Special  Article  (Sp);  Book 
Review  (BR);  Report  of  Meeting  (RM);  Poem  (P). 

— A — 


Address  of  Welcome  (Sp) 20 

Address  of  Welcome,  Response  to  (Sp)  21 

Address,  President's  Annual  (Sp)  1,9 

Address  on  the  62nd  Anniversary  of  Washington  County  Med- 
ical Society  (Sp) 63 

Advertising,  Journal  (E) . 79 

Agranulocytic  Leukopenia  with  Multiple  Peripheral  Neuritis 

(O)  - 113 

Allergy:  An  Everyday  Problem  (O)  71 

Allergy,  Recent  Advances  in  (BR)  124 

Allergy,  The  Relationship  of,  to  Otolaryngology  (O)  55,  77 

American  Medical  Association,  Report  of  Delegates  to,  85fh 
Annual  Session  (E)  17,49 

Anesthesia,  Spinal  (BR)  106 

Annual  Session  (E) 199,  217 

Annual  Session,  59th,  Proceedings  of  (Sp)  B 

Annual  Session,  60th,  Program  of  (Sp)  201 

Attendance  Records  (Sp)  5 

Arkansas  County  Medical  Society  (RM)  184 

Arkansas  State  Pediatric  Association  (RM)  204 

Auxiliary  Page  (Sp) 39,84,  104,  122,  139,  164,  187,206,220 

Auxiliary  Program,  llth  Annual  Session  (Sp) 206 

— B — 

Benton  County  Medical  Society  (RM)  52,  120,  204,  205 

Bethea,  O.  W.  41 

Blackburn,  E.  W.  (Ob)  ...  122 

Blankenship,  W.  H.  (Ob)  162 

Blair,  A.  A.  74 

Blood  Pressure  and  Pulse  Rate,  The  Effect  of  Postural  Changes 

On  (O)  172 

Body  Mechanics  (BR)  188 

Boone  County  Medical  Society  (RM)  . 184 

Bourland,  O.  M.  (Ob)  51 

Bulletin,  American  Medical  Association  (Sp)  122 

By-Laws,  and  Constitution  (Sp)  154 

— C — 

Cancer,  Educational  Material  Available  on  (Sp)  184 

Cancer  in  Women,  Health  Examination  in  Relation  to  ( O ) . 211 
Carroll  County  Medical  Society  (RM)  184 

Carruthers,  F.  W 167 

Cataract:  Its  Etiology  and  Treatment  (BR)  125 

Catechism,  Sickness  Insurance  (Sp)  175 

Chest,  Some  Suggestions  in  the  Examination  of  (O)  41 

Chiasmal  Syndrome:  Report  of  Cases  (O)  149 

Child,  The  Spastic  (BR) 69 

Childhood  Tuberculosis  (O)  74 

Circulation,  Publiher's  Statement  of  216 

Clinical  Endocrinology  of  the  Female  (BR)  26 

Clinical  Laboratory  Methods  (BR)  164 

Collom,  S.  A.  (Ob)  7 

Committees,  State  Society,  Annual  Report  13-18 

Colon  Dysfunction  (O) 143 

Congress,  In  (E) 152 

Constitution  and  By-Laws  1541 

Conway  County  Medical  Society  (RM)  I60| 

Conway-Pope-Yell  County  Medical  Society  (RM)  82 

Coronary  Disease  (E) 95 

Coronary  Thrombosis  (O)  87 

Council  on  Pharmacy  and  Chemistry,  Reports  of  (BR)  40 

Council,  Report  of  15 

Crawford  County  Medical  Society  (RM)  52,  120,  137,  204 

Crittenden  County  Medical  Society  (RM) 161 

— D — 

Darkfield  Diagnosis  of  Early  Syphilis,  The  (Ab) 90l 

Definite  Diagnosis  in  General  Practice  (BR)  140 

Delegates  to  the  American  Medical  Association,  Report  of 

(Sp)  17,49 

Diagnosis,  Physical  (BR)  223 

Diseases  of  the  Eye,  Manual  of  (BR)  691 

Diseases  Peculiar  to  Civilized  Man  (BR)  140 

Doctors,  Dollars  and  Disease  (A)  112 

Doctors,  as  Husbands  (P)  163 

Doctor,  A,  Needs  a Garden  (P)  119 

Drennen,  S.  A. 14 

Drew  County  Medical  Society  (RM)  136 

Drugs,  Useful  (BR) 

Dysentery,  Bacillary,  Sodium  Thiocyanate  as  a Prophylaxis  and 
in  the  Treatment  of,  With  Special  Emphasis  Upon  the 
Shiga  Type  (O) 216 


— MAY,  1935 

— E — 


Eighth  Councilor  District  Medical  Society  (RM)  136 

Election  of  Officers  (E)  117 

Electrocardiography  (BR)  189 

Electrosurgery  (BR)  • 39 

Elkins,  W.  N.  (Ob)  218 

Ellis,  R 211 

Encephalomelitis,  Acute,  Following  Vaccination  Against 

Smallpox  (O)  91 

Endocrine  Therapy  in  the  Climateric  (O)  194 

Eye,  Manual  of  Diseases  of  (BR)  69 

Examination,  Health,  in  Relation  to  Cancer  in  Women  (O)  211 

Examination  of  Pre-School  Children  (R)  3,  151 

Examination  of  the  Chest,  Some  Suggestions  in  (O)  41 

— F — 

Faulkner  County  Medical  Society  (RM)  160,204 

Ferguson,  J.  V.  (Ob)  51,  (R) 80 

Fetal,  Newborn  and  Maternal  Morbidity  and  Mortality  (BR)  54 
Fifth  Councilor  District  Medical  Society  (RM)  103,  160,  218 

First  Councilor  District  Medical  Society  (RM)  6,  120 

Fifty-Ninth  Annual  Session,  Proceedings  of  (Sp)  8 

Fletcher,  V.  B.  115 

Fort  Smith  Clinical  Society  (RM)  136 

Fourth  Councilor  District  Medical  Society  (RM)  136,  218 

Fractures,  Dislocations  and  Sprains,  The  Management  of  (BR)  39 

Fraternal  Delegate,  Report  of 16 

Fulmer,  S.  C 32 

-G  — 

Gastrointestinal  Disturbances,  Five  Unusual  Paralytic  Cases 

Following  (O)  1 14 

General  Surgery,  1933  Yearbook  of  (BR)  26 

Genitourinary  Diseases,  Synopsis  of  (BR) 140 

Gosnell,  C.  E.  (Ob) 38 

Grayson,  W.  B.  1 1 , 1 14,  197 

Gynecology  (BR) 140 

— H — 

Harrison,  A.  G.  (Ob)  96 

Hastings,  G.  114 

Hawkins,  M.  C. 101 

Hawkins  Bladder,  Vaginal  and  Rectal  Guide,  The  (O)  101 

Health  Examination  in  Relation  to  Cancer  in  Women  (O) ....  211 

Heart  Disease,  Practical  Talks  On  (BR) 124 

Heart  Visible,  The  (BR)  165 

Heart  of  Yours,  That  (BR) 106 

Hemorrhage,  Uterine  (O)  . 109 

Hempstead  County  Medical  Society  (RM)  160 

Hinkle,  S.  B. 46 

Hoge,  S.  F 213 

Holt,  S.  C 27 

Howton,  O.  (Oh)  7 

Hughes,  W.  E.  (R)  3 

Hurrle,  F.  E.  (Ob)  162.  (R)  181 

Hutchinson,  D.  A.  (Ob) 38 

Independent  County  Medical  Society  (RM)  67,  137 

Infant  Nutrition  (BR) 85 

I Know  Just  the  Thinq  for  That  (BR)  53 

Insurance,  Sickness  (E)  117,  182,  (Sp) 175 

— J — 

Jackson,  Geo.  F 18 

Jackson,  G.  I.  (Ob) 83 

Jefferson  County  Medical  Society  (RM)  67 

Johnson  County  Medical  Society  (RM)  160,  184 

Jones,  H.  Fay  H. 10,  160 

Jones,  I.  F 109,  152 

Jones,  I.  G 127 

- K — 

Kelly,  M.  D.  (Ob)  38 

King,  L.  E. 91 

Klugh,  Walter  E 91 

Knee  Joint,  The  (O)  107 

Knowlton,  Horace  A.  21 

Kosminsky,  L.  J I 

— L — 

Laboratory  Methods,  Clinical  (BR)  164 

Laboratory  Notebook  Method  in  Teaching,  The  (BR)  106 

Lanier,  L.  H. 77 


222 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  12 


Late  Syphilis  (O) 213 

Lawrence  County  Medical  Society  (RM) 7,  52,  136,  160,  205 

Legislative  Committee  (Sp)  135,  (E) 200 

Legislative  Policies  (Sp) 36,  135 

Leo  N.  Levi  Hospital  Conference  (RM)  82,  102 

Levy,  J.  S. 13 

Light  Therapy  (BR) 36 

Lincoln  County  Medical  Society  (RM) 6,  137 

Little  River  County  Medical  Society  (RM)  204 

Log,  Daily,  For  Physicians,  Colwell's  (BR)  105 

Lowe,  W.  W.  (Ob)  96,  (R) 101 

Lutterloh,  C.  H. 172 

— M — 

Madison  County  Medical  Society  (RM) 34 

Mahony,  F.  O.  (E) 4 

Malaria,  Therapy  of  (E)  66 

Malpractice  Insurance  (E)  ........  133 

Massey,  L.  D. 216 

Materia  Medica.  Pharmacology  and  Therapeutics  (BR)  85 

Maternity  Mortality  in  Philadelphia  (BR)  224 

Mann,  A.  H 149 

Mechanics,  . Body  (BR)  188 

Medical  Clinics  of  North  America  (BR)  224 

Medical  Economics  (E)  152 

Medical  Legislation,  Report  of  Committee  on  10 

Medical  Profession,  The,  and  the  Public  (BR)  69 

Medical  Service,  ERA  (Sp) 96 

Medico-Military  Symposium  (BR)  40 

Medicine,  A Manual  of  the  Practice  of  (BR)  165 

Medicine,  General,  Recent  Progress  in  (O)  32 

Medicine,  How  to  Practice  (BR)  190 

Medicine  Marches  On  (BR)  164 

Medicine,  Practice  of,  Hughes'  (BR)  188 

Medicine,  Socialized  (E) 153 

Medicine.  1934  Yearbook  of  (BR)  189 

Membership  (E) 79,  96,  133 

Membership  Roster,  1934  97 

Memoriam,  In  (E) 200 

Memorial  Session 23 

Mental  Hygiene  in  the  Community  (BR)  40 

Mentally  III,  Hospitalization  of  (A)  151 

Military  Medicine  and  Pharmacy  (BR)  188 

Miller  County  Medical  Society  (R)  151,  (RM)  160 

Millard.  R.  V.  87 

Miller,  W.  H.  (Ob)  186,  (R)  181 

Minor  Maladies  (BR)  140 

Minor  Surgery  (BR)  140 

Mitchell,  J.  G.  131 

Mississippi  County  Medical  Society  (RM) 67,82,  102,  136  184 

Mobley,  W.  C.  (Ob)  83 

Mock,  W.  H. 21 

Modern  Drug  Encyclopedia  and  Therapeutic  Guide  (BR)  54 

Monroe  County  Medical  Society  (RM)  5,6,205 

Moore,  A.  I.  (Ob) 7 

Moulton,  J.  G. 163 

Mystery,  Magic  and  Medicine  (BR) 54 

— Me  — 

McCaskill,  M.  E 15 

McKie,  W.  H.  (Ob) 83 

— N — 

Nature's  Way  (BR)  188 

Neurosyphilis,  Evaluation  of  Swift-El lis  Therapy  in  the  Treat- 
ment of  (O)  60 

New  and  Nonofficial  Remedies,  1934  (BR)  53 

Ninth  Councilor  District  Medical  Society  (RM) 34,  137 

— O — 

Obstetrics,  Progress  in  (O) 46 

Officers,  Election  of  (E)  1 17 

Otolaryngology,  The  Relationship  of  Allergy  to  (O)  55,  77 

Ouachita  County  Medical  Society  (RM).  34,  120,  136,  160,  184,205 
Ouachita  County  Plan,  The  (E)  ' 35 

— P — 

Paralytic  Cases,  Five  Unusual,  Following  Gastro-lntestinal 

Disturbances  (O) 1 14 

Park,  C.  E.  (Ob) 139 

Parmley,  Val  10  36 

Pascoe,  V.  L.  (Ob)  186,  (R) ’|98' 

Passional  Psychology  (BR)  69 

Patient,  The  Nervous  (BR) 223 

Patton,  C.  B.  (Ob)  7 

Payments,  by  ERA,  for  Medical  Services  (Sp)  80 

Pedjatrjc.  Association,  Arkansas  State  (RM)  204 

Pediatrician,  The  Complete  (BR)  105 

Pennsylvania's  Poor  Relief  Laws,  Summary  of  (BR) 124 

Phillips  County  Medical  Society  (RM)  161 

Physical  Diagnosis  (BR) 223 

Pneumothorax,  Results  of  (A)  196 

Policy,  Statement  of  (Sp) 179 

Pope-Yell  County  Medical  Society  (RM)  102,  104 

Postural  Changes,  The  Effect  of,  on  Blood  Pressure  and  Pulse' 

Rate  (O)  172 

Postures  and  Practices  During  Labor  Among  Primitive  Peo- 

.Ple  (BR) 105 

Prairie  County  Medica!  Society  (RM)  160 

President,  Our  (E)  4 

President's  Page  (Sp)  ||6 


Proceedings,  59th  Annual  Session  (Sp)  & 

Program,  Preliminary,  Auxiliary,  llth  Annual  Session  (Sp) 207 

Program,  Preliminary,  60th  Annual  Session  (Sp) 201 

Publisher's  Statement  of  Circulation 216 

Publishing,  One  Hundred  and  Fifty  Years  of  (BR) 223 

Pulaski  County  Medical  Society  (RM) 6,  102,  136,  160 

Pulse  Rate  and  Blood  Pressure,  The  Effect  of  Postural  Changes 

On  (O)  172 

Purifoy,  L.  A.  (Ob)  186,  (R) 181 

-9- 

Quinine,  The  Effects  on  the  2nd  and  8th  Nerves  (O) 1 3 P 

— R — 

Radiology,  The  1934  Yearbook  of  (BR) 164 

Radiologic  Exploration  of  the  Mucosa  of  the  Gastrointestinal 

Tract  (BR)  105 

Radiological  Technique,  Manual  of  (BR)  209 

Radium,  The  Indiscriminate  Use  and  Rental  of  (R)  115 

Radium,  The  Use  of  (R) 106 

Rhinehart,  D.  A 13 

Robins.  R.  B.  10,  35 

Robinson,  F.  C.  (Ob)  96 

Roster,  Membership,  1934  97 

Rudner,  H.  G. 143 

— S — 

Saline  County  Medical  Society  (RM)  52,  160,  184 

Scully,  F.  J.  113 

Sebastian  County  Medical  Society  (RM) 

6,  82.  102,  120,  137,  160,  184,  218 

Second  Councilor  District  Medical  Society  (RM)  102,218 

Security,  Economic,  Report  of  Committee  on  (Sp)  122 

Secretary,  Report  of 17 

Session,  Annual  (E)  199 

Sevier  County  Medical  Society  (RM)  160 

Shea,  J.  J 55 

Shepherd,  The  Sinister  (BR)  105 

Shipp,  A.  C.  20 

Shuffield,  J.  F 12 

Sickness  Insurance  (E)  117,  182 

Sickness  Insurance  Catechism  (Sp)  175 

Seigel,  G.  R 194 

Sixth  Councilor  District  Medical  Society  (RM)  67,205 

Skin,  Compend  of  Diseases  of  (BR)  70 

Slaughter,  J.  W.  (Ob)  200 

Smith,  W.  D 12,  191 

Smith,  W.  F.  15,  16 

Snider,  W.  L.  (Ob)  162,  (R)  162 

Spinal  Anesthesia  (BR)  ... 106 

Sputum,  The  (BR)  26 

Socialized  Medicine  (E)  153 

Sodium  Thiocyanate  as  a Prophylaxis  and  in  the  Treatment  of 
Bacillary  Dysentery  With  Special  Emphasis  Upon  the 

Shiga  Type  (O)  216 

Southeast  Arkansas  Medical  Society  (RM)  3,6,67,  102,  120 

State  Board  of  Medical  Examiners,  Report  of 16 

Statement  of  Policy  (So)  179 

Stevenson,  E.  H.  (Ob)  139,  (R)  130 

St.  Francis  County  Medical  Society  (RM)  204 

Stewart,  H.  V.  197 

Sullivan,  A.  G.  14 

Surgical  Clinics  of  North  America  (BR)  26,39,70,  124,  140 

Surgery,  Conservative  vs.  Radical  (O)  127 

Surgery,  General.  1933  Yearbook  of  (BR)  26 

Surgery,  Minor  (BR)  140 

Surgery  of  a General  Practice  (BR)  85 

Surgery,  Recent  Advances  in  (O)  27 

Swift-  El  I i s Therapy,  Evaluation  of,  in  the  Treatment  of  Neu- 
rosyphilis (O) 60 

— T — 

Tarver,  B.  F.  (Ob)  51 

Tarkington,  Grayson 60 

Tenth  Councilor  District  Medical  Society  (RM) 102 

Third  Councilor  District  Medical  Society  (RM)  136,  218 

Typhoid  Bacillus,  The,  in  Milk  and  Water  (O)  197 

Treatment  in  General  Practice  (BR)  . 26 

Treatment  of  the  Commoner  Diseases  Met  With  by  the  Gen- 
eral Practitioner  (BR)  40 

Treasurer,  Report  of  17 

Tri-County  Clinical  Society  (RM)  6,34,52,68,82,120,136 

Tuberculosis,  Childhood  (O)  74 

— U — 

Useful  Drugs  (BR)  224 

Uterus,  Carcinoma  of,  and  Treatment  (O)  191 

Uterine  Hemorrhage  (O)  109 

— V — 

Verrucae,  The  Treatment  of,  by  Local  Injection  of  Bismuth 
(Ab)  141 

— W — 

Washington  County  Medical  Society  (RM)  52,63,  136,  160,205 

Watkins,  P.  R.  (Ob)  186 

White  County  Medical  Society  (RM)  6 

Wood,  H.  D.  63 

Woodruff  County  Medical  Society  (RM)  102,  160 

Wootton,  W.  T.  ..  71 


May,  1935] 


ARKANSAS  MEDICAL  SOCIETY 


223 


BOOK  REVIEWS 


The  Nervous  Patient.  By  Charles  Phillips  Emerson,  M. 
D.,  Research  Professor  of  Medicine,  Indiana  University, 
Indianapolis.  Pp.  452.  Price  $4.00.  Philadelphia:  J.  B. 
Lippincott  Company,  1935. 

In  reviewing  "The  Nervous  Patient"  I am  impressed 
first  by  its  readability  as  contrasted  with  most  books  on 
nervous  and  neurologic  subjects.  In  Doctor  Emersons 
early  classification  of  nervous  patients,  one  is  made  to 
see  the  "Personality  Pattern"  of  his  cases,  and  divide 
them  in  loose  groups  of  introverts  and  extroverts.  This 
is  invaluable  in  appreciating  the  nervous  side  of  the 
medical  case,  both  during  and  following  his  illness. 

The  book  "The  Nervous  Patient"  briefly  and  yet  ac- 
curately outlines  the  symptoms  and  treatment  of  many 
medical  diseases.  The  psychologic  and  neurotic  ele- 
ment of  the  sick  patient  is  interestingly  dealt  with,  ex- 
plaining many  of  the  idiopathies  of  such  diseases  as 
allergies,  and  cardiovascular  neuroses.  More  and  more 
the  physician  is  having  to  deal  with  diseases  of  the  cir- 
culatory system,  and  digestive  tract,  which  through  lack 
of  more  information,  are  alluded  to  as  functional  and 
nervous  complexes,  for  example  "The  Irritable  Colon,” 
'Anginas,"  and  "Migranious  Headaches."  Such  terms 
as  "Psychoneurotic  Asthma,"  "Epileptic  Personality,"  "War 
Hysteria,"  and  "Emotionalism,1  are  made  clear  and  in- 
teresting, with  plans  of  management  and  treatment  out- 
lined. 

In  no  field  of  medicine  is  the  average  physician  more 
helpless,  nor  his  patient  more  hopeless  than  in  his  care 


and  treatment  of  the  neurotic  patient.  The  physician 
seldom  objects  to  losing  a hysterical  patient  by  his 
changing  doctors,  which  he  usually  does  many  times. 

Aside  from  the  clear,  detailed,  yet  brief  presenta- 
tion of  this  immense  subject,  my  chief  commendation  of 
"The  Nervous  Patient"  is  its  novel  like  readability. 


Physical  Diagnosis.  By  Warren  P.  Elmer,  B.  S.,  M.  D., 
Associate  Professor  of  Clinical  Medicine,  Washington 
University  School  of  Medicine,  Saint  Louis,  etc.,  and  W. 
D.  Rose,  M.  D.,  late  Associate  Professor  of  Medicine, 
University  of  Arkansas  School  of  Medicine,  Little  Rock. 
7th  Edition.  Pp.  82.  342  illustrations.  Price  $8.00. 

Saint  Louis:  C.  V.  Mosby  and  Company,  1935. 

This  is  an  unsurpassed  textbook,  made  more  compre- 
hensive by  the  numerous  illustrations.  The  word  descrip- 
tions are  most  concise  and  readable,  giving  the  prac- 
titioner an  opportunity  to  quickly  review  any  phase  of 
physical  diagnosis.  Its  general  acceptance  as  a worth- 
while volume  is  indicated  by  the  fact  that  it  has  pro- 
ceeded to  the  seventh  edition. 


One  Hundred  and  Fifty  Years  of  Publishing:  1785- 
1935.  Philadelphia:  Lea  and  Febiger,  1935. 

This  is  a revision  of  a similar  volume  published  in  1885, 
entitled  "One  Hundred  Years  of  Publishing."  The  story 
is  of  the  development  and  of  the  accomplishments  of 
Lea  and  Febiger.  The  publishers'  conception  of  the  re- 
sponsibilities inherent  to  their  business  is  modestly  stated. 
The  book  is  an  interesting  document  on  the  growth  of 
medical  publication  in  this  country. 


ACTUAL  PRACTICE  IN  SURGICAL  TECHNIQUE 

WITH  A REVIEW  OF  SURGICAL  ANATOMY 

For  information  as  to  Courses,  Fees,  Registration  requirements,  etc.,  address 
CHICAGO  INSTITUTE  OF  SURGERY 
2040  LINCOLN  AVE.  CHICAGO,  ILL. 


GRANITE  MOUNTAIN  HOSPITAL 

Open  to  All  Reputable  Physicians  and  Surgeons 

S.  P.  JUNKIN,  M.  D.,  Medical  Director 
Telephone  Rural  9579-F2  Route  4,  Little  Rock,  Ark. 


38  Years  Established 
RALPH  EMERSON  DUNCAN.  M.  D. 
Director. 


ALCOHOLISM  - MORPHINISM 

Successfully  Treated  by  Dr.  B.  B.  Ralph's  Methods 

SCIENTIFICALLY  equipped  lor  Diagnostic  Surveys,  Thera- 
peutic Procedures,  Rest  and  Recuperation.  Treatment  of 
each  case  established  by  clinical  history,  physical  exam- 
ination, laboratory  tests  and  individual  tendencies. 
Reasonable  fees. 

Address  THE  RALPH  SANITARIUM, 

529  HIGHLAND  AVENUE.  KANSAS  CITY.  MO. 

Telephone,  Victor  4850. 


224 


THE  JOURNAL  OF  THE 


[Vol.  XXXI,  No.  12 


Useful  Drugs.  A List  of  Drugs  Selected  to  Sup- 
ply the  Demand  for  a Less  Extensive  Materia  Med- 
ica  with  a Brief  Discussion  of  Their  Actions,  Use 
and  Dosage.  Edited  by  Robert  A.  Hatcher,  Ph.  M., 
Sc.  D.,  M.  D.,  and  Cary  Eggeston,  M.  D.  Prepared 
under  the  Direction  and  Supervision  of  the  Council 
on  Pharmacy  and  Chemistry  of  the  American  Med- 
ical Association.  Ninth  Edition.  Price,  60  cents. 
Pp.  203.  Chicago:  American  Medical  Association, 
1934. 

This  book  is  a recognized  work  in  its  field  and 
has  been  adopted  as  a textbook  in  a number  of 
medical  schools.  Obsolete  drugs  have  been  de- 
leted and  others,  the  value  of  which  has  been  es- 
tablished, have  been  added  from  time  to  time. 
The  statements  of  actions,  uses  and  dosage  of  the 
various  drugs  are  revised  after  discussion  by  the 
whole  Council.  They  represent  the  latest  and  best 
results  of  therapeutics  and  pharmacologic  revision 
The  Council  constantly  aims  that  this  book  shall 
present  a comprehensive  compedium  of  the  more 
useful  preparations  in  the  medical  armamentarium. 
As  it  stands,  the  book  is  an  authoritative,  intelli- 
gent, critical  and  entirely  adequate  reference  vol- 
ume for  the  use  of  the  busy  practitioner. 

Medical  Clinics  of  North  America.  (Issued  se- 
rially, one  number  every  other  month.)  Volume  18, 
Number  3.  New  York  number.  November,  1934. 
Octavo  of  301  pages  with  16  illustrations.  Per 
Clinic  Year,  Paper  $12;  cloth  16.  Philadelphia 
and  London:  W.  B.  Saunders  Co.,  1934. 

This  issue  begins  a New  Deal  in  medical  clinics. 
It  has  been  completely  revolutionized  and  the 
change  is  very  beneficial  to  the  general  practi- 
tioner. In  this  issue  we  find  a symposium  on  ade- 
nopathies which  is  a post-graduate  course  in  that 
branch  of  medicine.  Not  only  does  it  go  into 
minute  details  of  the  pathology  but  carries  it  to 
the  general  interpretation  of  its  clinical  manifesta- 
tions. 

We  find  the  everyday  "run  of  practice"  prob- 
lems featured  as,  "The  Failing  Heart,"  "Menstrual 
Disorders,"  "Pneumonia  in  Infants  and  Children," 
and  other  subjects  that  are  met  with  daily  in  the 
general  practice  of  medicine.  They  are  also  writ- 
ten in  a very  understandable  and  useful  technique. 
We  find  not  only  the  theoretical  side  of  the  sub- 
jects but  many  practical  points  for  everday  use. 

This  issue  is  the  first  of  the  new  medical  clinics 
and  the  issues  to  follow  are  certain  to  bring  more 
light  in  other  daily  problems,  especially  certain 
definite  clinical  manifestations.  In  this  manner 
they  wish  to  bring  to  the  reader  as  much  clinical 
"meat"  as  they  would  get  from  attending  a post- 
graduate clinic. 


Maternal  Mortality  in  Philadelphia:  1931-1933. 

By  the  Committee  on  Maternal  Welfare.  Paper. 
Pp.  144.  Price  $1.00.  Philadelphia:  Philadelphia 
County  Medical  Society,  1934. 

Obstetrical  practice  in  Philadelphia  was  exhaust- 
ively studied  under  Dr.  P.  F.  Williams.  The  excel- 
lence of  the  assembly  of  the  material  and  the  crit- 
ical analysis  was  the  basis  for  the  winning  of  the 
Strittmatter  Award  for  1933  by  Dr.  Williams.  The 
recommendations  for  the  improvement  of  condi- 
tions in  Philadelphia  may  well  be  applied  to  many 
other  communities. 


COUGHS 

(AS  ASSOCIATED  WITH  SMOKING) 

"After  smoking  the  diethylene  cigar- 
ette for  from  three  to  four  weeks . . . the 
cough  disappeared  in  75.6  percent.” 


Some  Clinical  Observations  on  the  Influence  ofl 
certain  Hygroscopic  Agents  in  Cigarettes. 

Laryngoscope,  1935,  XLV,  1 49-1 54* 


SEE  ALSO 

Pharmacology  ofl  Inflammation:  III.  Influence  ofl 
hygroscopic  agents  on  irritation  from  cigarette  smoke. 

Proc.  Soc.  Exp.  Biol,  and  Med.,  1934, 
32,  241  -245* 


The  results  reported  in  these  papers  find 
a practical  application  in  Philip  Morris 
cigarettes,  in  which  only  diethylene  glycol 
is  used  as  the  hygroscopic  agent.  To  any 
Doctor  who  wishes  to  test  them  for 
himself,  the  Philip  Morris  Company  will 
gladly  mail  a sufficient  sample  on  request 
below.  * * 


■■  Tor_exclusi v£_us.e^.of  practising  physicians 

PHILIP  MORRIS  8C  CO.  LTD.  INC. 

119  FIFTH  AVENUE  * NEW  YORK 

Absolutely  without  charge  or  obligation  of  any 
kind,  please  mail  to  me 

★ Reprint  of  papers  from  Laryngo-  I I 
scope  1935  XLV,  149-154  and  from  1 — 
Proc.  Soc.  Exp.  Biol,  and  Med., 

1934,  32,  241-245. 

★ ★ Two  packages  of  Philip  Morris  f~  1 
English  Blend  cigarettes.  — 


NAME. 


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